Wednesday, March 26, 2008

She's got the look...

I'm in Allergy this month. I am working with a wonderful Pediatric Allergist. As a resident in training, when you're in a specialty rotation like Allergy, things work a little differently. The Attending physician will send me in to the patient's room to see him or her first. I come out and 'present' the case to him and we then go in together and finish the encounter. During this second phase, I get to watch him interact with the parent and the child patient.

Something I've only noticed this month is the expression on the mom's faces as the doctor asks their child a question and their child answers.

There's the look.

The eyes light up, the face glows with warmth and pride and there's a playful smile on the lips as they almost try to mouth prompt the answers to the child. The roughest most confrontational adult is transformed when their attention switches from you to their child. The child, completely unaware, focuses on the doctor and answers the question. To me, the silent witness, the mom seems completely unaware of the expression on her face. The look.

A different patient room. A different child. A different mom. Ten, sometimes twenty times a day. Always, the same look.

Stories in Medicine: Poem: Waiting...

Stories in Medicine: Poem: Waiting...

Saturday, March 22, 2008

Who's the Adult?

It's another night of call in the ICU. I've got to say that I do enjoy being on call for the ICU. Last night, I got called from the ER to admit a 35 year old female who had ingested an unknown quantity of (we think) tylenol. Her blood alcohol level was also sky high. She was stupurous and could not provide any information. Needing information on allergies, medications and other illnesses and hopefully some details on what happened, I asked,

"How did she get here?"

"The ambulance brought her."

"Who called the ambulance?"

"She did."

I looked to see how 'she' was.

'She' was a 12 year old frightened little girl, holding an Easter bunny under her arm.

Apparently, this family moved to Wisconsin from California. They lived in a trailer. Mom didn't have a job and dad worked as a lineman. The little girl tried to answer my questions but clearly, most of the answers were wrong (she thought the anti-depressants were blood pressure medicine). This frightened child saw her mom drink, then ingest a large number of pills, then become stupurous. When her mom wouldn't respond to her, she tried to call 911 on their cell phone. Since she couldn't get a signal, she went over to someone's house, asked permission to use the phone and called 911.

As she bravely tried to answer questions from the nurses, doctors and cops (suicide attempts always bring the cops), she didn't cry, act hysterical or break down. At the end of it all, she looked up at my with wide eyes and asked

"Is my mommy going to be alright?"

It was 1:30 in the morning. Mom was shipped off to my care in the ICU while a cop took the child to a foster home three towns away.

Imagine you are 12 and this is the evening you have had. Dad is nowhere. You are being taken by a policeman to a town far away from where you live at 2:00 in the morning to live with people you have never seen before. She didn't know it, but because of the suicidal intention, Mom would not be discharged from the hospital to home. She would be transferred directly an inpatient psych facility to work out the suicidal ideation. Of course, this was assuming she made it through the night.

As a Med/Peds doc, I see both adults and kids in my practice. Although in this case, the 'adult' was my patient, my heart cried out for the little girl.

Who's the adult in this situation?

Saturday, March 01, 2008

It's a boy! No, it's a girl! No, it's a ...I don't know...

Peter is a 7-month old boy. No, wait. Peter is a 7-month old 'boy'. Okay, I'll start differently: Peter was wait. It is very hard to tell a story about someone without mention of their sex: either by use of a pronoun or by implication with the use of a name. Maybe in such cases, we should a name that could belong to a little boy or a little girl. I don't know. Okay, here goes...

A little baby was born and it was evident there were problems. The baby suffered from what is called Eagle-Barrett syndrome: a condition where there is complete or partial absence of the abdominal muscles, problems with the urinary system and in males, the testicles do not descend from the abdomen into the scrotum. In this baby's case, it had a single opening called a urogenital sinus -- a single opening for the urethra and vagina. It's complicated. Although the parents believed the baby to be a boy -- it seemed to have a penile structure and scrotal sac structure, genetic testing showed it to be a female. It had a genotype of XX. Imaging studies (ultrasound) showed the presence of what looked like a premature uterus and the scrotal sac was empty.

In the end, the parents made the decision (based on religious and other non-medical reasons) to raise their child as a boy. And so 'he' is. I got to take care of 'him' in the context of kidney failure and a febrile seizure (another story). I learned a lot from him.

Teenage girl angst

Those of you in residency know this is true: sometimes cases come in groups. Well, last night on call was the night of teenage girl angst. A colleague tells me that it is because it is a cold winter in Wisconsin.

We got a 14 year old girl who stood in front of her friends in a bathroom at school and swallowed a bunch of lithium and prozac tablets, then washed it down with windshield wiper fluid.

A couple of nights ago, we got another 14 year old who had a fight with her parents and swallowed a bunch of tylenol tablets.

Then there's the 14 year old whose weight is 75% below normal -- thin as a rake.

There was also the 13 year old with cut marks on her forearm made with a razor blade. She cut on herself because she was upset and depressed.

The 14 year old who has 'seizures' -- only they aren't.

I remember the teenage years being rough. But I wasn't a girl and so can't identify with the stories I heard:

"my parents don't understand me" "I'm not beautiful" "Life sucks" "they jump to conclusions about me" "I want to be with my friends but my parents won't let me"

Teenage girl angst.