After three wonderful weeks of UVA Pediatric Clinics (and one less-than-wonderful day of having surgery myself), I journeyed home to Richmond, Virginia for the second portion of my pediatrics clerkship! While this was technically my first "away" rotation, because Bon Secours is so close to my parents house I feel like it didn't really count as being "away." It's kind of a pain to lug all of your clothes and textbooks to a different place, BUT this was totally made up for free home-cooked meals every night :)
Prior to starting this rotation I had heard mixed things about doing peds at Bon Secours. The biggest drawback I was warned about beforehand is that St. Mary's is technically not a "teaching" hospital like UVA, so you have to be a little more proactive about seeking opportunities to do and see things. However, I found that 99% of the time if you show a little interest the attending is more than happy to teach you and let you do things! The other complaint I heard was the volume and variety of patients is not quite what it would be at a big center like UVA. This is probably a valid concern, but I think I ran into a good number of interesting patients over my three weeks anyway.
More importantly, there were a BUNCH of things I really liked about this rotation, including:
- "Night" Shifts: Which should really be called late evening shifts; because you only have to work from 3 pm to midnight! Even for super lame people like me who would go to bed at 8:30 every night given the option, midnight is totally doable. And at least in my experience, you get to do and see a lot more at night then you do during the day since its just you and one attending there to cover the floor. Overall the hours were really good on this rotation - I'd say I probably averaged somewhere in the 50-60 per week range!
Got to spend a lot more time here than I did on my surgery call nights :)
- FREE FOOD!!! I know it sounds too good to be true, but students eat for free in their cafeteria. Meaning I could have a normally $3.50 Sabra Hummus as many times a day as I wanted! I feel like I didn't make as much use of this as I could have since I was living at home, but it was a nice perk. Take notes, UVA ;)
Best day ever. Every day!
- PARKING!!! Another amazing thing at Bon Secours was that students get to park in the garage, meaning you only have to walk like 2 minutes outside from the garage to get to work. This is in contrast to UVA, where most students only get a parking pass for 6 weeks while on general surgery. The rest of the time, you have to walk (in my case) about 15 minutes up and down a massive hill since the buses don't start running till 7:30. Which is really fun in professional clothes on those 98 degree days with 100% humidity. Not that I'm bitter or anything.
- Freedom to do and see what you are interested in! Sometimes we would come in and there would only be like 8-10 patients on the floor. This was kind of a bummer because that meant we only got to round on a few patients each, but also kind of awesome because it meant we had a lot of free time in the afternoon after notes were finished. This gave me time to do fun things like watch tiny babies have surgery, observe imaging procedures that I heard about all the time but never actually seen (Upper GI series, MRIs, Ultrasounds for appendicitis rule out), and shadow attendings on GI/Pulmonology/Hematology consults. My personal goal every morning was to look at the admits from the night before and try to pick up as many cute babies as possible as patients. Which meant that if I had free time in the afternoon, I could go play with cute babies whose exhausted moms were happy to hand them off to someone with medical knowledge AND call it "checking in on my patients." I'm so clever sometimes :)
This particular cute baby is me - thankfully I grew into my ears eventually!
- Living at home! This has nothing to do with the rotation itself, but living at home is awesome! I definitely did not appreciate my home and parents enough as a child. Food is free, and you don't have to waste time grocery shopping or cleaning bathrooms. Plus parents have to listen to complain about your day no matter how boring you become. And its nice to have a furry friend who is always and unconditionally happy to see you!
Waiting eagerly for her family to return home!
Common things you will encounter and therefore should know something about before starting a general pediatrics inpatient rotation:
- Failure To Thrive: This was the most common diagnosis I encountered during my rotation. It might be because I swooped all of the babies, but I think no matter where you are or how aggressive you are about picking up babies as patients that this is a really important topic to know about! It has a really broad differential associated with it and its good to have an idea of what labs and tests to run. The most challenging this about this particular topic is that it often comes down to socioeconomic issues, which unfortunately cannot be fixed with penicillin or an inhaler. You don't learn much about how to deal with this in the pre clerkship curriculum, so I think FTT patients allow you to learn physicians can help in these situations.
- Common causes of fever and how to do the work-up: After failure to thrive, this was probably the second most common thing I saw in my patients. In kids who can talk its a bit easier because at least they can tell you what hurts, but babies get the whole nine yards (Blood culture, urine culture, lumbar puncture, ect.) since they are not quite as articulate. Turns out pathogens can hide almost anywhere!
- Vomiting and Diarrhea: Again, this has a really broad differential ranging from over-anxious parent to some pretty scary emergent surgical conditions, which makes it important to know how to tell the difference. Also read about acute management of dehydration (all that fun fluid and electrolytes stuff YET again!)
- Croup: I'd say we saw several of these patients every week. Another good reason to practice listening to breath sounds. Tip: don't include epiglottis on your differential just because the kid is drooling. You will probably get laughed at.
So I was going back through my last couple posts and realized I have written very little about swimming lately. This is mostly because my swimming has been so inconsistent for the past couple months. On my surgery rotation, I usually had like 50 min per day to swim. On pediatrics, I had more time, but then I had surgery myself and missed a whole week. I also missed out on one of my favorite races right after my surgery, and since I don't have much else coming up it's been hard to be motivated to do big crazy sets. Luckily, I'm starting to feel stronger again and getting slowly back in shape. The times I was holding were not particularly impressive, but just so my swimming readers don't give up on me here is one of my workouts from this weekend:
I still use this, I promise!
Getting-Back-In-Shape Workout (done in SCM):
800 Choice Swim
400 Kick: 100 Fly/100 Free x2
400 Pull: Every 4th 25 is backstroke
all IM's are moderate to strong effort
400 IM Swim on 6:30
2x400 Free with Paddles on 5:30; negative split by 200
400 IM Swim on 6:30
4x200 Free Pull on 2:55; odds buoy between legs; evens buoy between ankles*
400 IM Swim on 6:30
8x100 free on 1:30:
first 4 are free swim desc. 1-4 to MAX effort
second 4 are free with paddles desc. 1-4 to MAX effort
8x50 on :55
Odds: Double arm backstroke
Evens: Free Swim
TOTAL: 5600 Meters
*I am TERRIBLE at pulling with the buoy between my ankles. The stupid thing comes out like every 3rd flip turn. However, Boyfriend says ankle-buoy stuff is really good for building arm and core strength. More importantly, he also likes to remind me that his 9-10 year old girls have absolutely no problem with ankle buoy sets...
Next up, I have an almost-finished post on studying for the Pediatric Shelf as well as a post on having surgery from a medical student's point of view! Have a great week everyone!