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.

And… Switch.

It is switch it up day again.

I still hate changeover days.  I don’t like the unknown of going to a new rotation.  I dislike finding new offices, sorting out times to go to new clinics and all that stuff.  The unknown kind of sucks.

I was really sad to leave Peds Onc.  Minus my episode of semi-depression after the first week and a half, it has been a fabulous rotation.  Kids and Oncology… Not much else more to love!  At least to me as an Oncology resident who not-so-secretly sometimes wonders if Peds is the place for her.

Seriously, it was a great rotation.  I learned how to do cool things like lumbar punctures (poking needles in spines… and administering chemo) and bone marrow biopsies.  And I don’t even like procedures, but those are similar to taking blood and I do get strange kicks out of taking blood.  I learned a ton about kids cancer and chemo drugs and such.  But the bigger piece is that I got to know some super awesome families and play with some fabulous kids.  I actually followed some kids almost weekly in clinic, and a few of them I followed from diagnosis as an inpatient.  In the world of a resident where you are forever darting in and out of services, that kind of consistency is pretty exciting.

Now, I am off to Family Medicine.

My Dad that I should get a by and not have to do it given the med school I went to.  Not so much.  But it is true, I have already done over 12 weeks of Family Med and another 4 of general community Internal Medicine (which in some contexts is still a lot of primary care).  That makes me feel prepared for the rotation, at least.

Family as a med student was one of my best and one of my more liked rotations, but part of that was the doc I worked with was a person I got along with famously.  It helps.

My orientation was good.  The clinic is nice.  I am fascinated by the electronic medical record.  It will be my first time using one in a non-hospital setting.  I am intrigued because I am very pro-EMR (seriously, I wrote a whole health systems paper on them during undergrad).

I start with my first patients tomorrow in clinic.  Whoo.  I find the hardest part is figuring out what people want and what things I need to review and what things I need supervision for.  It seems everyone is different, so it is always a process.

The thing I am most angsty about is that the service also covers their own obstetrics.  Although this isn’t the main thing I am supposed to be doing, I may have to go to a few deliveries (so not my thing), although I will be thrilled to do some prenatal visits (my favourite thing after seniors and babies).

Such is the adventure of new rotation.  You take the good with the bad and figure the rest out as it goes.

This is rotation number 12 of residency.  Our physics exam is at the end of the month, then we are done that for the “year.”  I will no longer be a PGY 1 in just two months (eep).  It is crazy how this stuff flies by.

Genuine Feeling Placement

I sometimes struggle with being genuine with people.

I don’t want people to feel sad or take on my hurt.  I also don’t always know what to say.

This weekend, we were home and I was being asked every seven seconds how work is going, what rotation am I on and then when I say Peds Onc they gasp and tell me how terrible or difficult it must be.  I don’t like to burden other people with my feelings, so I always smile and say things are going well and that I like Peds Onc.

It isn’t like I am lying.  I am doing well on my evaluations, things are going smoothly at work and I LOVE peds and I LOVE oncology, I would even say I LOVE Peds Onc.  But, last week was a bad week and there is only so much life-ruining, hard-hitting stuff one can deal with before a person gets feeling down.

My honest answer this weekend should have been that Peds Onc broke me.  That my week was awful and yet amazing.  But, I think that would freak people out.

I have been having problems verbalizing that.  I just don’t really know where to put what I am feeling, how to process what has happened and then say it in a way that doesn’t make me burst into tears or put off other people.  Plus, to top it all off, I don’t want people to think I am weak or can’t handle it, especially when it is something I think I could do for the rest of my life as a part of my practice.

So, all weekend, I smiled and answered in half-truths and avoided the meat of the issue.  I tried once or twice to verbalize it, but I am not good at that at the best of times.  I am the person that people go to with their problems.  I am not good at being the person that goes to others…  And often when I try to bring up how tough it is, that just gets turned around into a how tough the other person would find it or some other random thing.

It gets frustrating sometimes.

Patrick tries to get it, but he admits that he can’t.  I have other resident friends, but their experience and outlook are obviously different than mine, although they help.

I don’t know where to put what I feel.  I can’t process telling 15 year olds about relapsed cancer and having parents who are at a similar age and stage in life break down crying because their baby is sick.  I in one breath say cancer in kids is very curable and in another realize that that means nothing to the child who isn’t cured.  I am having a hard time trying to figure out what to do with it at the end of the day.  I normally am fine with that kind of stuff.  I accept death as a part of life.  Illness as something we go through.    I have cared for people my own age before… But, the kids scare me more.

I keep imagining what if they were my kids.  I keep worrying about my unborn baby’s potential to develop a neuroblastoma.  How we would cope with months of chemo and surgery and radiation.   It breaks my heart to see any kid sick, but the thought of my own child being sick paralyzes me.  It actually causes me to reconsider having kids (just for a second).

I have a hard time processing because despite how much the bad stuff sucks when people are little and young, I feel guilty that I don’t have this tough a time in the adult world.  At least not always.  I can rationalize the treatment potential.  I can more easily accept that adults die, sometimes young.  Adults seem less helpless, even if sometimes that is untrue.

I have a hard time processing because it is difficult to see God in some of these situations.  I step back now and I see Him everywhere, but sometimes in the moment, even after the moment, I question and that scares me.

I have a hard time processing because I am supposed to be able to deal with this stuff.  And I want to do this in my practice and how can I do that if I get upset every time a kid gets diagnosed?  I know compartmentalizing is not healthy, but there needs to be some degree of this to function appropriately.

I felt as if I was broken.  I felt sad.  And yet, I was loving my job, which made me feel a bit more awful in a sense.

Some of this is because it was a busy week and I was tired.  But, some of it is because I care.  Some might argue I care too much.  I like to think I am human.  But, my human-ness needs to take a breather sometimes.

I don’t know where to put these feelings.

But I am glad I have them.

I am glad I can try to put myself in other people’s shoes… Even if my perception isn’t always accurate.  I am glad that I can bond with a little child over “Toopy et Binou”, that a Grandmother can feel comfortable spilling her guts to me, that most kids do get better and grow up and do things just like me.

I need to take care of myself.  I can’t take it all on myself.  But, it is good that this bothers me.  And that I love it despite that.

So, no, work isn’t a cakewalk, but it is going well.  I am on Peds Heme/Onc and my heart breaks for these kids and families every day, but I still smile more than I frown and I am happy and am enjoying myself even though I sometimes feel sad.

So yes, I was down this weekend.  And yes, I find it frustrating that I can’t always effectively verbalize how I feel, especially to people who are just asking a general question.  Sometimes I just don’t feel like talking about it. And that is okay.  Sometimes, I come home and cry a little and that is okay too (although I probably won’t admit that to your face).  Interestingly, despite all that, I am kind of  happy except that I feel I have to lie about how I feel overall.

The good thing is that this work does make a difference.  Even when the outcome is not what we like to see.  And I love kids and want to see them live as fully as they can for as long as they can.  Because that is what it is really all about.  That is why I want this potentially incorporated in my practice

Everyone feels down sometimes.  Different things eat away at us.  It is interesting how sometimes the very thing that breaks your heart can also be a thing that brings you much joy.

I don’t know where to put these feelings.

I just wish I had a word to honestly explain them.

Black and white… The contrast in my world today.

I was reminded this weekend that there is so much goodness in this world.  That people care about one another and harbour love and empathy that we don’t always notice.  I watched complete strangers listen to one another’s stories about the cancer journey and love each other well.

Today, though, I was reminded of how much hurt and violence there is in the world.

  • I watched as parents were told their son has cancer and even with all of the aggressive treatment, he has only a 60% chance of cure (in the kid world, that isn’t that great).
  • The hospital I work in went into lockdown because of some sort of altercation.
  • Some person or people set bombs off at the Boston Marathon.

It blows my mind the contrast between my weekend and my Monday.  It feels very black and white.  Good and evil.

I know that is life in the fallen world we live in.

But today, it feels disheartening.

Today, I am grateful for so much and yet I seem to want for even more.

It makes me want to ask “why?”

But all I can do is hope and pray and hold on to the things that are good and right in the world.

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.

Sinking in Sarcoma

Much of my life of late has been consumed by sarcoma.

Thankfully, not because I have one, but because I am doing a presentation at my home program’s resident rounds about them.  And I did one on my last surgery rotation about them.

In fact, it seems sarcoma predominates my current status.  I even saw a kid in emerg last week with a giant belly mass for which sarcoma was on the differential (I assumed more because all I have been doing is reading about sarcoma).  But, I was following up on the case and it turns out I was right… Sadly.  Although there are other things that could have been worse.

Last night, Patrick started decorating for Christmas.

I worked on my sarcoma presentation.

This was the view from my corner of the dining room table (and you know I must be serious when I am actually sitting at a table to do work).

Our blended winter family was spying on me as I worked.  The littlest one was hiding behind my laptop screen.

Our blended winter family was spying on me as I worked. The littlest one was hiding behind my laptop screen.

Tomorrow, the presentation will be over and I can finally use some of my extra time to do something not sarcoma (like catch up on the peds reading I am getting behind on… Or, Christmas shop).  I love presentations though.  And the nerd in me loves preparing them too.  I am clearly not right in the head.

Sarcomas are interesting.  I am focusing on extremity soft tissue sarcomas, so tumors made up of cells that were once muscles, fat, the lining of our joints and such.  There are over 50 subtypes, yet, they are only 1% of adult cancers.

The main treatment of a sarcoma is surgery.  But, good quality surgery specifically.  A good resection can be the difference between life or, well, a short life.

The other big sarcoma treatment is radiation.  Because there are so few sarcomas, there are limited really good quality trials on it and because there are few trials, the treatment, although signs point to it changing, has been fairly consistently surgery followed by radiation.  More and more evidence and practice based observations suggest it might be better to irradiate up front, possibly with chemo.  But, there is little to actually scientifically test it on.  So, it is a debate.  A big one in the field.

This debate came up during my surgical rotation when I presented on the debate itself.  Despite all kinds of retrospective studies suggesting radiation up front could be better, there is only one trial that looked at it and it ended early.   Surgeons are hesitant to send patients for radiation first.  Radiation oncologists would love to radiate first.

But, if patients don’t come until the chunk is out, there is really nothing you can do.  Well, except educate.

That is where good interdisciplinary teams come in.

In fact, I read a study about how the whole decision thing is very profession dependent, despite all of the people being aware of the same literature and guidelines.  Because there is so much ambiguity in guidelines.

Things are changing.  We don’t work as much in isolation.  But, we are still set in our ways.  And we love evidence.  Which is tough when evidence is forever limited by rarity.

I think that is why I like sarcoma.

It is different.  It is a bit controversial.  And it is diverse.

Kind of like people.

It taught me a good lesson in variability in practice, the need for good research and also the importance of the patient (until the last 20-30 years, amputation was the way to go with these… Thank goodness someone had the bright idea to try to improve things).

The whole presentation thing also reminded me that as much as I love this stuff, I still want to do the whole festive thing and pretend to be normal once in a while (aka not secretly fascinated by sarcomas).  And that eventually many things look more fun after hours of work, including the heap of dishes in the sink.

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.

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.

https://i2.wp.com/www.cartoonstock.com/newscartoons/cartoonists/tne/lowres/tnen15l.jpgFirst 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.

https://i0.wp.com/www.sciencephoto.com/image/291627/350wm/M8250726-Foreign_body_in_child_s_nose-SPL.jpgPicking 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.