Tuesday, January 29, 2008

Childrens Hospital, Milwaukee ER

It's been a while since I last wrote in this blog...

I spent January in the Childrens Hospital of Wisconsin in Milwaukee, working in their ER. This is a pediatric ER. What a wonderful experience! The attendings, nurses, care partners, residents and fellows were all very colleageal.

Of course, the stars of the show are always the patients.

During the course of the month, I treated a LOT of upper respiratory tract infections: bronchiolitis, asthma exacerbations, influenza, common cold and such. Then there were gastrointestinal problems -- diarrhea, vomiting, stomach upsets.

Of course, there were unusual things too and those are always interesting...

A 1 year old dared his 4 year old brother to lick a road sign... in the middle of winter. Those of you who live or have lived in cold climates can imagine what happened next. Yup, his tongue stuck to the sign. Although helpful passers-by used water and other 'tricks' to get his tongue loosed, he did sustain a laceration as a piece of his tongue tore open as a flap. Ouch! He initially went to an urgent care facility where some well-meaning soul tried to suture the flap back (after a painful injection of numbing medicine). The stitches didn't hold. Fortunately, the tear was superficial and he was sent home to allow the tongue to heal on its own.

I got to sew lacerations on the scalp, palms, arm and face. I hate to admit it, but I really do enjoy repairing lacerations. I enjoy suturing. With the kind of numbing creams we have these days, it goes much better than I remember from own experience being stapled when I cut my forehead as a child. One kid fell asleep while I sewed a laceration ('lac' in our ER slang) on his face! We had only given him local anesthesia, nothing to put him to asleep. I guess he was just bored.

Not all stories have happy endings. My last day in the ER reminded me of what a city's ER can bring in, all in one day. My colleague saw a 12 year old who came in with a fever. A few blood tests later, we had the grim diagnosis: leukemia. There were teary eyes among several of the staff as a physician went into the room to give the family the bad news they were hearing for the first time. We see so much fever, coughs, colds, stomach aches and such in the ER. Every so often, the diagnosis is as grim as this was.

I saw a 13 year old who complained in front of his brothers, sisters and mom of a sticky discharge from his penis. Well, after I had cleared the room, the rest of the story emerged. Sparing details, he lost his virginity at 12 and had 2 sexual partners at 13. He did not used condoms. We tested him for all sexually transmitted diseases and involved a social worker to uncover more of the story.

I saw a 28 day old baby girl with a fever and drowsiness. Per protocol, we had to rule out meningitis, which meant doing a spinal tap. Both parents hovered nervously near me while I inserted a needle into their little baby girl's spinal column. I think as an intern, I would have asked the attending to do the procedure. But with some experience now, I was able to calmly re-assure them while I sought to obtain the precious spinal fluid that would give us our sample for analysis. Outwardly confident, I did pray that the Lord would give me success the first time round. He did and I was able to get clear spinal fluid without complications. Peds is interesting in that the presence of anxious and nervous family members watching you do delicate procedures brings some pressure to perform. I am grateful for the training and role models I have had that have taught me to do this correctly, confidently and successfully.

On the diversity side of things, I got to impress my attending physician one happy day when we saw a spanish-speaking patient in the morning. I guess it came to her as a surprise that being from India, I could speak spanish. In the evening, the last patient of the day spoke hindi. My attending began to wonder if there was a language I could not speak. To answer a question, I had to call for an interpreter when a Hmong family came next.

I will miss Milwaukee and the Childrens Hospital's ER. A funny thing: by the end of every month, I find myself thinking "this is great! I could do this for the rest of my life. Maybe I should do a fellowship in (fill in the blanks -- NICU, Peds ER...).

So what else did I do in the big city on my time off? I confess: there is no Indian food in Marshfield. I ate Indian food practically every day and thoroughly stuffed my face. The viral gastroenteritis I came home with on my last day when I 'overdid' the 'all you can eat buffer' was a small price to pay...