Fit To Write (This one time, I got a concussion…)

This week’s Writing Challenge from the Daily Post is right up my alley.  It is called “Fit To Write” and is about what health means to you in one context or another.

Well, gosh… This is a blog written by a resident, so gosh, health comes up a fair bit.  So, it must work.

Today, I will tell you a bit of what happens when the resident becomes patient.

A week and a half ago now I got my first concussion.  Well, the first concussion I know about for sure.  I  mean, I was pretty much an accident waiting to happen as a child, so I wore a helmet a lot (not just when I was on a bike… Yes, I was that cool.), but there were at least two times I hit my head hard enough to black out, albeit just for a second…. And I never told anyone until I was an adult (it is lucky I have gotten this far in life, come to think of it).

Image from vodkaandcupcakesdotcom.wordpress.com.

I cracked my head off of a cupboard standing up from emptying the dishwasher.  Something I do all the time.  Seriously.  I hit my head daily.

This time, though, I felt an instant headache and saw stars and thought I might be bleeding.  I got Patrick to check when he found me still half stunned.  No blood.  Win!  I popped a couple Tylenol and went on with my night.

I blamed the persistent headache on too much sun.  Then, on stress from the inlaws visiting.  The, fatigue.  Then, it hit me.  I know these symptoms.

But, no.  I was convinced I was a hypochondriac.

It was almost 24 hours later when I made the headache and dizziness and all around weird feeling worse by watching TV and I only really put the pieces together then.  This, after, only narrowly changing my mind about going to the gym with the Child just hours before.

But, I mean, what does a concussion change?  And how could it be a concussion?  I hit my head like that all the time.

But it was.  I woke up the next morning just as awful.  The act of even walking down the hall and thinking about going to work made it worse.  I called in sick.  I called my doctor.

You know it is a big freaking deal when I actually call my doctor.  I haven’t been to the doctor for a new health concern since the time Patrick made me go to emerg when I fell down the stairs on vacation.

I kept considering not going to the doctor. I tried to convince myself that I was a hypochondriac.  I am pretty sure that is the epitomy of hypochondriasis.

The thing is, I know the treatment for concussions.  I did two months of emerg.  I watch hockey.

Rest.  Mind numbing, boring total brain rest.

Image from girlsandprose.wordpress.com.

That includes no reading, no TV, no activity.  Just lying on the couch trying to nap and trying not to think of all the ways you could gouge your eyes out.

So, on day one, I cheated.  Patrick and I played a game .  I tried to read a journal article for work.  My head got worse.  But, really, I was still in denial.  And being a hypochondriac and telling myself I was a hypochondriac.

Image from momsteam.com.

But then, I saw my doctor (well, the doctor on call at the clinic my doctor works at).  She made me complete the SCAT2 form (aka a concussion score).  I got a full neuro exam.  My score was high but my exam was normal (minus some weird nystagmus my friend H pointed out to me in Med 2).  Concussion.

I walked out with a note for an additional minimum 2 days off work and orders to make my husband empty the dishwasher now.  And  detailed instructions on doing nothing and gradual return to activity.

I remember giving patients the spiel about this.  I felt for them.  It sounded gosh awful.  But getting the spiel when you feel that gosh awful already is even worse.

I have a new empathy for people on bed rest.  I have an even bigger new empathy for people who are on concussion brand rest.

Patrick is a saint for not killing me.  I think he could be a rich man for the number of times  I exclaimed “I’m bored.”

That being said, he found some bright sides.  He was less bored because he had company around the house.  And he and several others pointed out that maybe this is God’s way of making sure I get the rest I need.

Ugh.  Rest.

On day 3 of being home, I got to go to the grocery store and read a few pages of a book.  I got dizzy.  But it was good.

I finally went back to work that Friday.  I was never so strangely pumped to get back to work.  Even if I knew I couldn’t take a full patient load or stay the full day.

We went away for the weekend.  I still couldn’t drive, or run, or read for prolonged periods.  But, I got to see great friends.  And yes, I definitely did too much (like decide I felt great all day and hopped on a roller coaster… Fact… That is an AWFUL idea.).  But, I felt human again.  I could concentrate. 

I am back to work like normal people.  I can do homework like normal people.  I can drive again.  And I went to the gym for a half workout and felt good.  The only two things that have made my head hurt so far this week were intense grilling on rounds and trying to run the seven flights of stairs to the floor I work on.  Both don’t make a person feel great at the best of times.

So yes, I survived a concussion.  I was not the picture of the perfect patient.  But I learned some valuable lessons.  And I think I value my health a bit more.  I have never missed 3 consecutive days of work for anything but vacation.  I have never not cooked a meal for Patrick and I for almost a week.

Plus (brace yourselves for a follow-up post), I discovered how awesome audiobooks and podcasts truly are!

I am so behind in reading for work and working on my research it isn’t even funny (and yet, here I am blogging).  But, feeling healthy again is worth it all!

Have you ever had a concussion?  What about mind-numbing bedrest?  I would love to hear about your misery since you had to read about mine.

Breakfast and a library: being “festive” on the long weekend

I worked an overnight shift last night, so I felt horrendously tired this morning.  Probably because I went to bed at 5 and was too wound up to sleep until at least 6:30, which isn’t that much earlier than I naturally wake up.  So, my morning was actually when I was woken up by Patrick at 1.

Did I mention I hate shift work?

The good thing is that it was my second to last shift.  And my next one is a day shift.  I quite like day shifts (although the nights are nice because then we can go out and do errands like normal people during the day… like open a savings account like legitimate adults).

The other good thing is that my night shift was relatively sedate.  As it turns out, Friday nights on long weekends are less crazy when it is pouring rain.  The weather keeps some of the craziness away or prevents it from happening.  As someone who doesn’t adore suturing, drunk people or mass traumas, I am cool with that.  Plus, it is nice to not see people getting mangled.

Anyway, back to my “morning…  Patrick is my superhero because he made me blueberry pancakes with real maple syrup.  It is my first actual breakfast food breakfast in bed.  And I was literally woken up to a plate by my face.

Image from lotsofhumor.com.

The way to my heart is through my stomach.

Our post-overnight shift and first day of the Canada Day long weekend festivities were riveting.

We went to the library.

In our defense, it is pouring rain, I have to work again tomorrow and, well, the library is awesome.

Going to the library is generally trouble for me because I always want to get a bunch of books and I still have a heap to read at home and I have this thing called a day job.  I picked up three books… Baby Proof by Emily Giffin, Half Baked by Alexa Stevenson, and a book both Patrick and I will read called The Uke of Wallington by Mark Wallington.  I could have grabbed ten, so I consider it an accomplishment.

The library was a suspiciously popular place today.  Like, parking lot full and crawling with kids kind of popular.

As it turns out it was sign up day for the Summer reading program.  And, well, it was also raining.

I felt all nostalgic.  Apparently, now a days, you can win prizes for the number of books you read.  When I was a kid, we got stamps for every ten we read and a book mark.  Gosh, I miss those days.

Now, we are back in and safe from the sogginess.  Who knows, maybe we will attempt to go out and be social and try to do some Canada Day festivities tomorrow night after work or on Monday.  We will at least creep on the fireworks while the cat freaks out.

I am looking forward to reading, and Patrick is being a superstar and cooking supper.  We are so festive.

Losing memory and licenses

Last week, I wrote my first letter to officially take away someone’s license.

I had been involved with these scenarios as a med student and, as a resident, I have told people not to drive for so long after a procedure or taking a medication.  But, this was a first.

We saw someone in emerg with advancing dementia.  This person had gotten lost in their own neighbourhood twice and once drove 10 minutes in reverse because it was easier than getting turned around.  They were being aggressive towards their spouse who kept suggesting they shouldn’t drive and they came in because there was a question if the new worsening in behavior was due to an infection.  It wasn’t.

I have said before that dementias are the thing that kill me inside.  I can deal with them, but I find it exceedingly tough.  This from the oncologist-in-training.  Most people say that cancer is one of those things they like to avoid.  I don’t mind it.  Not saying it is easy, but I have found ways to cope.  There is hope in the grave situation.  Chances for cure or quality of life.  And I have ways to cope with people with dementia too.  But, for whatever reason (probably because of my family) impending forgetfulness without a defined endpoint or fix is worse than possible impending death and disability for me to observe.

Any situation can have some hope.  And in medicine, you learn to process those things.  But, memory loss strikes a chord with me.  Maybe it always will.

Back to my story…

So, after we rule out all of the reversible stuff, there is a conversation about where to manage things and about safety.

I had to tell this person they can no longer drive. This person who is the same age as my grandfather who just died.  This person who has been driving their entire life.  Who lives far from everything.

But, to complicate things, their judgment is poor.  Their insight is absent.   “I just forget a few unimportant things.  Who needs to know the date or the season.  That isn’t needed for driving,” they say.  They blame their spouse.  They yell at me.  They threaten to harm themselves if they can’t drive.  To destroy the car so nobody can enjoy it.

I empathize.  I mean, I can’t imagine what I would do if someone told me I couldn’t drive.  When I had that terrible torticollis earlier this year, I couldn’t drive for a week (something about moving one’s head that is important to the driving process) and I didn’t like it.

I empathize because my family had the discussion that when my grandfather lost his license, it would kill him.  I empathize because it crushed him, even though he was so sick, to hear that he shouldn’t drive.  I empathize because I have had family members get upset because I seemed to be stopping them from doing something they thought to be harmless for their own protection.

I had to explain that I will be sending a letter to the motor vehicle branch.  That they can be arrested and fined if they are caught driving.  That they are at risk of hurting someone, even though they would never mean to.  And that if I didn’t say something, I could be fined.

I know in my head anything I say won’t make a difference. That it is still, to that person a blow out of left field.  And that they will forget as soon as they leave and their poor spouse will have to deal with their anger.

I left to get something and came back.  They had already forgotten I told them not to drive.

I can’t imagine what it must be like.

I wrote the letter and dropped it off with the admin assistant to be sent.

I keep thinking of that person.  Their family.

My parents take care of both of their mothers.  Both of whom have Alzheimer’s .  They present very differently.  One is relatively easy, childlike.  The other is difficult and can, at times, be downright nasty.  They are both (as of yesterday) in facilities to keep them safe and help with their care.  Where we don’t have to worry quite as much about them getting hurt or lost.

Because really, keeping people safe is important.  But, sometimes it is more of a struggle to balance the safe and happy.

When I see people coming in, especially when these changes are new, I recognize the scared looks.  The uncertain questions.

I find it hard to not see it from their eyes.  Maybe because I am living it from the other side (when I can be there or at least vicariously).  Also maybe because I fear that one day I will be that family member or even that person.

I know it won’t be the last letter I write.  Or the last person with memory deficits I see.  I hope it will get easier, less personal.  But at the same time, I hope I keep the empathy.

Painful procedure

I think we are mean sometimes in adult medicine.

Okay… Not this mean… Image from quickmeme.com.

I don’t mean the heartless jerky kind.  Well, at least I am not, although buddy who I refused to give a narcotic script for a knee sprain may argue that I am.

Today, I did a lumbar puncture.  A difficult lumbar puncture.  On someone who may have had a subarachnoid hemorrhage.  Meaning, they had the worst headache of life.  And then I came at them to stick a needle in their spine.

This is something you have to do from time to time.

I have done many lumbar punctures.  All of them to this point were in kids.  Sedated kids.

Now, I am doing one in a large, not sedated, uncomfortable adult.

Big difference here, boys and girls.

Sure, we use freezing.

That alone hurts like stink.

But we do all this.  And it took a few adjustments before we got fluid.  All without sedation.  Fully awake with just the pain meds for the head.

Image from diagnosisms.org.

It seems mean.

Then, I saw someone with a huge laceration.

You know the bigger they are, the harder they fall?  Well, it is true.

I couldn’t find any topical anesthetic, so I had to inject lidocaine into the area.

Have you ever injected something that stings into the appendage of someone three times your size who is terrified of needles?

I can now say I have.

I actually had to get sedation.  And even that didn’t really help.

It took me and two people holding, as well as enough sedatives to make me comatose to get the freezing in, let alone suture the wound.

And then someone found something topical.

Just in time to make me feel like a big jerk.

We do that to kids.  But, they have topical cream and if they are really stressed we give them drugs to make them loopy.  And generally they aren’t big enough to kill me.

I also want to argue that adults should know how to suck it up.  But, that isn’t always the case.  But, sometimes I feel like we don’t do great when that is the case.  When someone has a legitimate phobia and can’t cope.

Why do we routinely sedate kids for lumbar punctures and make sure their procedures are as pain free as possible, but for adults, we often make them suck it up?  It isn’t that much more complicated to do it.  Sure, sometimes there are observation and airway concerns.  It is more time consuming.  But, sometimes, as someone who isn’t big on procedures, I think it would make the procedure easier on everyone.

Ah, sedation. Image from animal-space.net.

Do I think everyone should get emla cream before needlesticks?

Heck no.

But, I do think we should offer options for more painful procedures more readily than we sometimes do.  Especially people with irrational fears.

And that is what I think makes us mean.  In, reality we are just doing what we can with the time, resources and training we have.  The culture is not always one such that change happens quickly, especially if it isn’t a huge safety concern.

I won’t be doing tons of procedures in my future career (thank goodness), but I hope that the combo of the peds experience with seeing people go through icky stuff with some procedures in the real world will make me remember to try to offer good pain/sedation options when doing procedures, especially those that are extremely anxiety provoking.  I know I won’t be perfect and sometimes things can’t be helped because it just isn’t practical or reasonable, but at least it will be worth a try.

And just so you know, sometimes painful procedures are painful for the person doing them.  Maybe not as much for the person on the receiving end, but nonetheless, it can still be unpleasant.

Dumb ways to die (or not)

Since it was my first day in Emerg and I managed to not kill someone (it is disturbing how this never ceases to excite me, even though I realistically would never kill someone, the fear exists), but did hear of some people being injured in strange ways, I figured I would show this lovely video the Child sent to me earlier today.  Clearly everyone should watch a cheerful, animated video about dumb ways to die. 

It is amazing the stuff that people do to themselves, or allow others to do.   I remember being around when a person came into the emergency department with a beer bottle stuck on, well, a piece of his anatomy the beer bottle shouldn’t have been near.  I saw a girl who swallowed to magnets because they were using them as fake lip rings, but weren’t allowed to do that, so she “hid the evidence.”  And a guy who burnt himself when trying to jump over a campfire.

Why do people do those things?

But, thus brings up the question, why do I do stupid things?  To make myself feel better, I like to tell myself, at least they aren’t as stupid as some of the things other people do.  Such is human nature, to compare ourselves to others.  But really, I think everyone does a few stupid things.  Maybe not at the dumb ways to die or epic story that will live forever way… But at least in the, “gosh, that could have turned out badly” way.

Clearly natural selection isn’t always all it is cracked up to be.

The “Peds Sick”

When I was in med school, we used to say that the multitude of illness one would get during their pediatric medicine rotation was the “peds sick.”  I did remarkably well during that rotation and did not develop the “peds sick” until my birthday and the last week of the rotation… I am festive like that.

During this emerg rotation, I got a plethora of sore throats and gut grief that seemed to turn out to nothing more than a sore throat and upset stomach.  I thought I had made it out alive.

Wrong.

I had two shifts remaining and then I was in the free and clear.

And at Patrick’s work party on Saturday night I ate the most delicious greek food.  Only to become suddenly ill a couple short hours after.

Not a fan.

Foolish “peds sick.”

Patrick says he can differentiate a sick Trisha and a not-so-sick Trisha based on her medication use.  We had to leave the party early because I was feeling so horrendous.  I promptly came home an downed a full dose of Pepto-Bismol (I hate ALL liquid medications with a passion that befits a two year old) and gravol.

All was to no avail.

I will spare you the graphic details, but I am sure I nearly overdosed on ginger gravol and pepto over the next 24 hours, at least I would have should it have stayed in my system long enough to take effect.

The things that get etched into your mind at convenient and not so convenient times. Image via nursingcrib.com.

The worst part about being sick when you know too much is that you basically watch the changes happen in your body.  I knew the estimated percentage of dehydration I was in. And I had an hour long mental debate with myself around 4 in the morning as to whether I should just attempt hammering down some fluids or continue to dry out.  I have a relentless fear of vomiting, so generally hammering down fluids is a bad idea to me, however, the dehydration symptoms began to gain on me by 10am, so I started to attempt rehydration, including sending Patrick out to get me some Gatorade after church (and of note, I am deathly against the use of Gatorade or Powerade in any circumstance except post-gastro rehydration or in elite athletes).

Yesterday is kind of fuzzy.  Lots of sleeping and random TV.  And disgustingly sweet convenience store slushie and Gatorade in an attempt to replete my fluids.

It was clearly a failed effort.  I awoke feeling less nauseous, but still totally crummy from dehydration.  I guess it could have been worse.

And Patrick is not sick… Yet.  He is kind of a ticking time bomb at this point.  No matter how aggressive we were with handwashing, closed toilet lids and lysol wipes, he is likely screwed.

So, here I am camped out at home.  I can’t go to work because that would just be seeding my last bits of enterovirus or whatever around.  Plus, I get tired after walking a few steps.  And I just kicked the extreme nausea around lunch time.  Fortunately, my capacity for fluid is a bit higher today, so I think I am back up to just 5% total body water depletion (the muscle cramps are fading and there are tears in my eyes again!).

The bright side to all of this is a day of catching up on TV, knitting and reading.  The downside is that I really, really need to finish my Christmas shopping and that I HATE missing work.

I come from a family that rarely missed time.  For better or worse, the attitude has been that if you can walk, you can work.  I think overall this is a good work ethic, except with things that are massively contagious.

Image from readingamidstthechaos.blogspot.com.

I work in a profession that encourages everyone else to stay home when they are sick, but really, we get criticized.  I heard people talking the other day about how residents miss too much time because we have the option to take sick days on certain rotations and that we have some sort of back up.  Some physicians claim to have never needed a sick day.  They clearly never got gastro from working in peds emerg.

I do think it is important to limit sick time and maximize productivity.  I also think we work with a vulnerable population who would not be impressed to hear that I could hardly get out of bed just the evening before.

I feel torn about this culture.  I do like the commitment and I think sometimes we just need a kick in the pants.  I also think the system needs to account for the fact that sometimes people do just plain get sick and shouldn’t have to feel sick with guilt for missing a day.

So, I sit here.  Still feeling a bit guilty.  Sucking on a freezie and blogging.  Because that is all I can do.  At least I am no longer barfing.  And I am almost done the Powerade.

Sick days are so wasted on the sick.

Rain On My Parade

Sometimes a person can do some silly things.  And those silly things can bring great joy (and dampness).

This was one of those days.

I worked today.

In the morning it snowed.

Image via flickr.com.

I regretted not wearing socks with my shoes.  I am not generally a huge snow fan, but it was looking a lot like Christmas (*cue song here).  And it was all pretty and wintery outside.

Then, it stopped snowing.  That was even better… I could walk home, hopefully before it changed completely to rain.

3 kids came in with lacerations.  All of them were received playing outside on the playground during lunch at school… Promising.  That meant kids were outside.  That meant it wasn’t raining and it couldn’t be that wet out.  The walk home won’t suck that much after all.

I finally get out of work after sewing up hole in face number three (bonus… none of the kids slapped me today).  I start to walk towards the exit when I see it… The water.  Everywhere.  It is raining.  Not just raining.  It is pouring.  Mammals were falling from the sky.  And it is windy and hovering just above freezing.

Pretty much what I saw when I looked out the window. And a bit what it felt like… Except cold. Image from nashvillescene.com.

I am wearing a wool peacoat.  No hood.  Old flats… No socks, but a potential leak.

Epic fail.

I contemplate hiding out in the library at work.  I do have a giant presentation to prep for.  But wait… I have no memory stick and all but two of the papers I printed are at home.

I weigh out the options.

25 minute walk… I will freeze and drown.

Taxi… $7.00 to drive 5 minutes.  Not bad, but really, I am kind of cheap.

Bus… There is a stop near our building and near the hospital.  Timing will be about the same.  I won’t melt from a few minutes outside.  Seems like a happy medium.

I check the schedule and start walking.  The bus was on time (I was amazed at this after my experiences at our prior home).  But, by the time I got to the stop I was drenched.  I was literally dripping.  My shoes were squishing and I was cold, but at least not frozen.

At first I sat on the bus kind of bitter.  For 5 more dollars, I could have taken a taxi.  But, then I was a mother wrangling a kid away from a puddle walking down the street.  I remembered how fun that was and decided to look at the bright side.

This looks so fun. And it is. So long as you don’t mind being soggy. Image from creativecoolcatcontemplations.blogspot.com.

I am an adult, on my own, soaking wet, with another brief walk in the rain ahead.  I could be bitter and cold, or I could embrace the weather and my already soaked feet.

So, I embraced the weather.  On the way home (don’t kill me, Mom), I splashed through every puddle.  I mentally frolicked (we live downtown, so I can’t do something too ridiculous like actually frollick, at least not without the partnership of another person).  I sang the song below to myself because it seemed appropriate at the moment (not aloud, that would get me committed).

I did this all the while wearing a wool peacoat, dress pants and carrying a brown leather messenger bag and patterned lunch box.  I am like a child-working adult fusion.

By the time I got to the building (one minute at the most), I was really no soggier than I was before, but I was pretty happy feeling, despite my drowned rat appearance.

Me minus the life preserver.
Image from blogs.cornell.edu.

The cat drank the water I dumped out of my shoes (true story).  I had to change pants and dry off.

It confirmed again that I really should invest in some rain boots, but like a coat with a hood, there is an astute probability I wouldn’t have them when I needed them.

But, it was a strangely satisfying experience overall.

Funny how life works sometimes (this may be an indicator I still need to correct my schedule after the weekend or that I have been spending far too much time with children).

As Heard In Peds Emerg

Do you remember the whole “Kids Say  The Darndest Things” show?

I do.  I loved it.  Even as a kid.

Sometimes, working in a Pediatric hospital is like living in a big prolonged episode of the show.

Last night, I worked my second overnight shift in a row, so things were a bit funnier, especially once it was about 4 in the morning.  We all had a bad case of the giggles and there were some especially entertaining kids.  Those combined with some of the others I have seen leads to a pretty fun list of funny things to say.

“Mom, you are driving me crazy.  It is time for a brief time out.”  Said by a four year old while holding their head and sighing in frustration.  Not like they heard that from a parent before.

When asked how the child likes their new school, she resonds, “I like it much better, they appreciate me there.”  This was met with hysterical laughter from every adult in the room.  The kid just stared at us like we were all stunned.  We asked what she meant and she explained that they just seem to give her more attention and praise her talents.  Makes sense.  Interesting choice of words, but sensible.

In response to how was it getting stitches one boy said, “It was better than that time Dad sat on me.”  Mortified, his parents explained until recently, they had to pin him down for any kind of needle.

One little girl in with the stomach explained to me all about how she threw up in a bucket… After throwing up on both her bed and Mom’s bed.  And that because she threw up in a bucket, she got a cookie.  Which she threw up, and not in the bucket.  A lot of detail Mom was not impressed she shared.  Especially about the cookie.

One five year old who was not really sick informed me she wanted to stay in the emergency room with me.  Like a sleepover.  Except she could stay up all night.  And play with the other kids.  Because it would be fun, right?  Wrong.

While examining a boy’s obviously broken arm, I asked if he thought it was broken.  He informed me he played another couple minutes of his hockey game before going off the ice.  So no.  His forearm was at a 45 degree angle.  He wanted to go to school the next day to show the others before getting a cast on.

I was slapped in the face by a five year old who didn’t want me to give him stitches.  It hardly stung.  His mom was mortified.  His older brother and I laughed a little.

A 4 year old with gastro asked me, “am I going to make it?” in a croaky, sad voice with big sad eyes.  Five minutes later while I was explaining it was the probably the stomach flu, she asked if she could have something to eat, maybe something light… Like pizza or a milkshake.

I was informed by a 16 year old patient that I looked just like a girl from her school and was asked if I was some kind of freaky smart kid or something.

“I can’t move my arm… Like this.”  As she moves her arm.

I was asking a child with hives if they ate anything different today.  They told me, “I sometimes eat my boogers, but today I tasted some of the stuff out of my ears.  Is that why I itch?”  Their Mom promptly said, “yes.”

While doing a procedural sedation, one 14 year old boy told us all about his girlfriend, how she would do his homework while he was in a cast and how she was beautiful and we should creep her on Facebook.  He woke up and swore up and down he had no girlfriend and panicked that his parents might have heard.

Child when asked if they have an itchy bum.  “Sometimes, but Mom doesn’t let me scratch it like dad does, but sometimes, I steal a fork from the kitchen, because that isn’t my hand.”

I think part of the fun of peds is that the kids are sometimes just a bit more honest, or at least funny in their lies.  And they don’t embrace the sick role as much, so you can sometimes have a bit more fun with them.  Plus, they are kids.  And just plain funny sometimes.

Playing All Day and Other Fun In Peds Emerg

It is Medical Monday, boys and girls.  This is the first Monday of the month where medical blogs from all over the place link up for a blog hopping adventure.  Be sure to check out some of the other posts!

I love pediatric emergency medicine.  I think I have stated this fact previously.  But, I do.

And not because I am a sadist who likes screaming children.

But because it is a satisfying job on many counts.

First of all, I have all of the cool toys (minus the kids who come in with iPads or their DS or whatever).  A stethoscope is like gold to most kids under 8.  You listen to them, they listen to Mom.  The wee ones chew on it (on that note, the stethoscope is a bit of a sesspool… thank goodness for antibacterial wipes).  The otoscope, although one of the more scream inducing exams for the really wee ones is also a fabulous distraction method.   I love that I can play and do an exam.  I don’t always love that I have to wrestle my cool and very expensive toys out of their hands at the end of the visit.

Kids don’t look at you like an idiot.  You can do a neurologic exam on children without having them stare at you like you are an idiot when you start telling them to “walk on a tightrope” or “puff out your cheeks.”

I find putting on casts a very satisfying activity.  Nothing better than a good quality cast.

On a related note, kids love to see their own x-rays, even if they are normal.  I love being able to show them.

Picking small foreign bodies out of orifices is strangely rewarding.  First of all, because in the end the kid feels better.  But also because you just never know what you might find.  Clear sparkly elastics, Barbie shoes, window stickers and rocks are just some of the findings I have had.

Many times, all a kid needs is a good dose of Ibuprofen and a popscicle to be back to themselves.

You get hugs and cuddles that aren’t creepy throughout the day.

Most of the visits are not at all emergencies.

Did I mention you get to play a lot?

The major downfall, is that you get sick.  Because kids cough and sneeze and pee and puke all over the place.  That is what makes life interesting, I suppose.

Nonetheless, if I didn’t love doing the whole oncology thing so much, I would consider this.  Instead, I will simply be a parent.  And possibly do a bit of pediatrics in my practice.  At least  then it isn’t a constant barrage of contagious illness.

“Don’t be one, get one!”

I am back on my vaccine rant.  I wrote about it previously, with regards to the flu shot. I saw a video I thought was relevant.  I have also seen a few cases that are relevant.

I am on peds emerg, as you have probably noticed and well, I see a lot of sick kids.  And kids get sick.  No matter what you do.  Such is life.

But, I saw a 25 day old  baby who was very, very sick with the flu.  His Mom and two older siblings were sick earlier in the week and gave it to him.  Now, his life was at risk.  Maybe they would have gotten the flu anyway, but maybe if they had all been vaccinated, they would have protected their youngest sibling.

Rick Mercer, a delightful Newfoundlander who talks on all sorts of subjects did one of his “rant with Rick” features about flu shots.

Don’t be one, get one!

I also had a small battle with some parents who refuse to vaccinate their children (that is one’s own call). The concern was that they kid had cut his head open on a rusty nail and I suggested the tetanus vaccine.  They refused.  I reviewed the risks of tetanus.  I didn’t realize that they were against vaccines, I just thought he was due for one.  They started ranting at me about autism and stem cells.  I presented the evidence, but they made their own decisions.  That is a right we have.   I just informed them of what to watch for, reviewed risks and benefits and took some deep breaths.

I get it.  We all need to be educated in our own ways.  We all have our own ethical-moral decisions to make.

But, when I see little babies who may have whooping cough, a preventable illness, or people spreading the flu like wildfire, I can’t help but question it.

There is no evidence for the whole autism thing.  Heresay, some experiences, but no scientific evidence.  The one study that suggested it was a sham. Autism runs in families, it is a different way of thinking, not something that kills children.   Often, when you see children with autism, you may notice that the parents have a few traits.  Not always, but sometimes.  I have seen fabulous healthy people who happen to have autism do all kinds of fantastic things in life.

I can’t fix what has happened to families.  I don’t know why your kids were perfect and suddenly changed.

I do know the risks of dying from those diseases are higher than the risks of autism.

And I do know vaccine formulations have been changed to avoid thimerosol, the preservative everyone is scared of, where possible.

And I know people worry about the stem cell lines used in production of the vaccines.  That is a moral issue and I can’t really judge on that.  But I do caution people to think long and hard about the decision.

I am sure you recall Penn and Teller.  They also do a very entertaining, but educational feature on vaccines.  I have it included here, but I will warn that there is some VERY strong language at the end of the video, so please don’t watch it if you are sensitive to this or have others around (the first time I saw it was on a peds ward nursing station looking for presentation material… oops).

The moral of the story again is that vaccines save lives more than they take them.  And I feel very strongly about them.  I also understand others feel strongly the other way.  That is their opinion, just like I have mine.  I just wish it wouldn’t have such an impact on others.

I promise I will give this rant up for a little while now.