Pediatrics: Wards and All
March 6, 1999
Saturday
Dear everyone,
This is the long-overdue journal issue on my 2-week stay in the Pediatrics wards. I’m so glad it’s only 2 weeks. In the past years, the ward rotation was 3 weeks You see, a new curriculum was implemented for our class, which is why the ward rotation (and Pediatrics as a whole) is now shorter. There used to be a 10-week stay in Pediatrics, as opposed to our 8-week rotation.
Enough of that. Here goes my experience in the wards. First of all, I’d like to mention that my stay in the wards was greatly eased by very kind and helpful residents: both the first-year residents who directly manage patients and the senior resident who supervises all of us. The daily rounds did not take too long, since our quick-thinking senior resident easily evaluated and analyzed our patients’ conditions, without compromising the learning process. While other services (one ward is handled by 3 services, or groups of doctors; each service can have up to 17 patients, making a 51-patient capacity ward) would take around 5 hours for rounds, we would only take about 3 hours. This is generally from 9 AM to 12 noon (which means other services extend beyond lunch); if ever we extend rounds beyond that, we break for lunch first then go back to rounds (other services make rounds till 2 pm and then have lunch). I guess our residents understand that the stomach must be satisfied in order to have the brain function optimally. Another factor that shortens our rounds was that our service was benign (meaning most of our patients weren’t overly sick or in terrible condition) – this is by pure luck and maybe prayer.
One thing I hate about Pediatrics is that you have to get blood from babies and toddlers Especially newborns. as they are so fragile and (most of the time) cute. No problem with older kids, usually about 7 years old and above, they usually understand that this is all part of being sick.
Any child younger than that is sure to squirm and make your needle go out of position (unless the child is held tightly by the mother). Plus the crying! It either makes you feel pity for the kid or makes you lose concentration and distracts you from doing the blood extraction well.
Then there is also the “mommy” problem, which has many forms. Sometimes the mother begs you to stop trying to get blood from her child since she feels so much for the kid Or the mother may start going “tsk, tsk, tsk” and in the process pressuring you to find that blood fast and if you can’t, she’d go into “talk to the baby” mode “kawawa ka naman baby, tinutusok-tusok ka ayan na ang bampira, kumukuha na ng dugo, tiisin mo lang yan baby, para sa iyo yan anak, wala na, matatapos na…” [rough translation: “poor baby, getting stuck again by the vampire, getting blood, be patient, it’s for your own good”… even if you are far from finished, this really puts pressure on you to finish your bloodwork]. And the ultimate type of mommy problem, the refusal to allow anyone to get blood from the child Some mothers give in to you after some convincing, others after a lot of convincing, and still others outright refuse to let you touch her child – to the extent of writing in the child’s record, “Ayaw kong kuhanan ng dugo ang aking anak, (sgd) name of mother” [rough translation: “I refuse to have blood drawn from my child”]. Oh well, if we interns can’t get blood, we can refer to the residents who we presume are better at this task. Then it would be their problem already. As for IV [intravenous] line insertions, if the intern cannot find an uninjured or correct-sized vein, patients cannot get “lined”. The plan would then be referred to a resident again.
Monitoring patients (vital signs) is different in Pedia. There are normal adult ranges for, say, blood pressure, but with kids, there are normal ranges for every age group. This makes things confusing, as one does not know immediately whether the vital signs are normal or not. What’s more, we need to monitor temperature too (unlike in adults). A thermoscan (a newfangled instrument* you put into the ear canal for about 3 seconds, which measures the temperature of the blood here) is a great time-saving device. Without it, you’d have to tell every mother to put a thermometer in the patient’s mouth/rectum/underarm and go back to her child some minutes after to check the temperature. If you have to do this every hour, it would be such a time-waster. Another thing with monitoring for pediatric patients is one has to match the blood pressure cuff to the size of the patient’s arm, not like in adult care, in which arms are generally all the same length and width.
Pediatrics involves lots of computation, which is why a calculator is very handy. Medicine doses and IV fluid rates are computed based on the weight of the child. There are also mnemonics (actually formulas) for estimating ideal weight and height for age groups. This is also another reason why I don’t like Pedia – too many computations, too many things to remember (like for example, developmental milestones – what abilities are normal for a 1 year old kid can start walking without support, say a few words, etc.) Don’t get me wrong. I’m not a kid-hater. Kids are OK if they’re well and active, but once they’re sick, it’s depressing. They’re not cute anymore.
It’s easy to get donors for child patients It’s easy for people to take pity on kids, which is why there are lots of donors coming to the pedia wards They donate cash, medicine, food and clothing, but sometimes these aren’t enough. Other sources must be found.
OK, end of first issue. Watch out for the second, which will be about the Nursery (and maybe a little on the Pediatric ER).
55 days to go
26 in Pediatrics
29 in Community Med
Notes:
* Apparently the thermoscan was a new thing in the late 1990s, and it was life-changing.
JOINT is the Journal of INTernship, a series of email messages to family and friends (“journal subscribers”) written during my yearlong medical internship from May 1, 1998 to April 30, 1999. Internship is one of the requirements before taking the Philippine Physician Licensure Examination (also known as the Medical Boards). Journal entries were edited for clarity in January, 2020. Read more about it in the first blog post, Introducing JOINT.
