It's 11:17 pm. I was on call last night. We admitted a 7 month old little boy. He was really cute, but irritable. He had presented with a 12 day history of fevers, cracked lips, injected conjunctivae and a passing macular rash. He was transferred to us with suspicions that this could be Kawasaki disease.
We did indeed think this was Kawasaki. Although he did not have all the classic symptomsWe admitted him and got him started on the appropriate treatment: IVIG (Intravenous Immunoglobulin) and high dose aspirin.
Now the bad news.
We knew this could happen. We got an echocardiogram today and he has coronary artery beads that are interpreted to be signs of a coronary artery aneurysm . I am upset and depressed about this. He is 7 months old! While this is a known sequence of Kawasaki, we were hoping that we were in time with treatment.
There is something about a post-call day. You have been on for 30 hours. You are hungry, your stomach probably burns from too much coffee, eating at odd hours, disrupted sleep cycles and who knows what else. You are washed out and running on fumes. To get bad news on a day like that makes it tough.
Something hurts inside. Frustration. Couldn't, can't do anything about this bad finding. Of course, we will 'follow' and react appropriately. Possible future events include thrombosis of the coronary artery. He is 7 months old!! We will probably get a repeat echo in 6 weeks. The anuerysm could either have resolved by then or we could have a giant aneurysm. I am hoping for the best.
I think I hate Kawasaki disease. I hate that we do not know what causes it. What a tease and frustration.
This is one of those days when you wrap your coat about you and press into the cold wind to go on.
Addendum on 12/24/2006:
The follow up echo was done 6 weeks later. The arteries returned to normal. Life is sweet! Merry Christmas!
Saturday, October 28, 2006
Friday, October 27, 2006
5 year old versus motor propeller
I am post call today. It was a busy night and by the time I had got home, it was about 3 in the afternoon. I had been in the hospital 33 hours without sleep. Lots had happened. I finally got to send one of our little 5 year olds home today after a 2 month stay in the hospital.
About 2 months ago, he had been boating with his family. He fell into the water and the propeller from the motor slashed into him on the left side, fracturing his scapula, breaking ribs, cutting into his spleen, pancreas, left kidney, small bowel and large bowel. He also had a femur fracture on the same left side.
Shortly after being admitted, his spleen, left kidney and portions of his bowel were removed. During his long hospital stay, he underwent a number of surgical procedures and needed extensive skin grafting to close up the abdominal wound. While the graft didn't exactly take, his abdmomen is healing.
It was emotional to send him out. There were a lot of specialists involved in his care and it was a nightmare to put together his discharge documents -- so many issues to address for follow up and I was afraid something will be missed if I did not document it thoroughly and go over it with the mom. I got to see his abdominal wound today (perhaps for the last time). If you compare it to a normal 5 year old's abdomen, it would be considered almost frankensteinian with suture marks running in different directions and triangular shaped red scar tissue visible medially and laterally. But if you think about where he has reached, it is a beautiful sight. He will need plastic surgery in the future, but for now, he is alive and going home. I shall miss him.
I was proud to be part of his care. I almost feel like I was sending one of my own babies home. He is a medical miracle and an incredibly brave little boy. I wish him well.
About 2 months ago, he had been boating with his family. He fell into the water and the propeller from the motor slashed into him on the left side, fracturing his scapula, breaking ribs, cutting into his spleen, pancreas, left kidney, small bowel and large bowel. He also had a femur fracture on the same left side.
Shortly after being admitted, his spleen, left kidney and portions of his bowel were removed. During his long hospital stay, he underwent a number of surgical procedures and needed extensive skin grafting to close up the abdominal wound. While the graft didn't exactly take, his abdmomen is healing.
It was emotional to send him out. There were a lot of specialists involved in his care and it was a nightmare to put together his discharge documents -- so many issues to address for follow up and I was afraid something will be missed if I did not document it thoroughly and go over it with the mom. I got to see his abdominal wound today (perhaps for the last time). If you compare it to a normal 5 year old's abdomen, it would be considered almost frankensteinian with suture marks running in different directions and triangular shaped red scar tissue visible medially and laterally. But if you think about where he has reached, it is a beautiful sight. He will need plastic surgery in the future, but for now, he is alive and going home. I shall miss him.
I was proud to be part of his care. I almost feel like I was sending one of my own babies home. He is a medical miracle and an incredibly brave little boy. I wish him well.
Lonely in residency
3.28.2006 12:48 am ...
I just came off call today. It was a long 36 hours stretch at the hospital that was busy with some highs and lows, tense moments and good moments. I came home by 3:30 pm. I was so tired, I think I went to sleep without eating anything. I was scheduled to go to a christian prayer group meeting at 7:00 pm
My eyes opened at 8:30 pm. For a moment I didn't know where or when I was. Then it hit me. I had missed the meeting I was looking forward to going to for a month. Drats! If you don't want to hear me whine, then don't read on...
I feel a sense of frustration. With the life in residency being what it is -- screwed up sleep routines, odd, disjointed times off, it is so difficult to have a life. I got up depressed and frustrated with myself that I have not been able to meet any of these meetings that I wanted to go to.
I called the hospital and found out that one of the kids we had admitted on call -- that we thought had Kawasaki -- has coronary artery anuerysms. It hurts to think of it. I wanted so much to talk to someone about my feelings. But, who? It is 10:30 pm at night. Who could I call at that odd hour?
Residency can be lonely. Because of the hours I do not have much of a social life. Since I do not drink, the bar scene doesn't work for me. I would love to join a class or group or something, but with my call schedule that keeps changing, I don't think I could make the classes. Who would put up with me anyway? They wouldn't see as much of me as they might wish and I might want to call or meet with them at odd hours of morning or night. My days off may come on a week day and I may work 3 weekends straight.
Okay. So I'm post-call and tired. Still...
I just came off call today. It was a long 36 hours stretch at the hospital that was busy with some highs and lows, tense moments and good moments. I came home by 3:30 pm. I was so tired, I think I went to sleep without eating anything. I was scheduled to go to a christian prayer group meeting at 7:00 pm
My eyes opened at 8:30 pm. For a moment I didn't know where or when I was. Then it hit me. I had missed the meeting I was looking forward to going to for a month. Drats! If you don't want to hear me whine, then don't read on...
I feel a sense of frustration. With the life in residency being what it is -- screwed up sleep routines, odd, disjointed times off, it is so difficult to have a life. I got up depressed and frustrated with myself that I have not been able to meet any of these meetings that I wanted to go to.
I called the hospital and found out that one of the kids we had admitted on call -- that we thought had Kawasaki -- has coronary artery anuerysms. It hurts to think of it. I wanted so much to talk to someone about my feelings. But, who? It is 10:30 pm at night. Who could I call at that odd hour?
Residency can be lonely. Because of the hours I do not have much of a social life. Since I do not drink, the bar scene doesn't work for me. I would love to join a class or group or something, but with my call schedule that keeps changing, I don't think I could make the classes. Who would put up with me anyway? They wouldn't see as much of me as they might wish and I might want to call or meet with them at odd hours of morning or night. My days off may come on a week day and I may work 3 weekends straight.
Okay. So I'm post-call and tired. Still...
Wednesday, October 11, 2006
Poem: Waiting...
I went to a writing group meeting the other day and one of our assignments was to write a poem. The theme was "waiting". Well, I guess I had the ICU on my mind when I wrote this:
Waiting…
The monitor beeped in the background
As the machine took another breath.
Tubes carried food and water,
As the bed bore up life and death.
They came several times a shift:
White coats, green scrubs or plain,
Checked numbers, connections and flow rates;
Today was there weight loss or gain?
“Mr. Jones! Mr. Jones! Mr. Jones!”
called a tired but firm young voice.
Tired eyes above an endotracheal tube
Opened to silence the noise.
The intern left after data gathering,
Leaving a sea of tubes and pumps.
Amidst them, a Mr. Jones closed his eyes
Again to resume the waiting…
Waiting…
The monitor beeped in the background
As the machine took another breath.
Tubes carried food and water,
As the bed bore up life and death.
They came several times a shift:
White coats, green scrubs or plain,
Checked numbers, connections and flow rates;
Today was there weight loss or gain?
“Mr. Jones! Mr. Jones! Mr. Jones!”
called a tired but firm young voice.
Tired eyes above an endotracheal tube
Opened to silence the noise.
The intern left after data gathering,
Leaving a sea of tubes and pumps.
Amidst them, a Mr. Jones closed his eyes
Again to resume the waiting…
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