Post-Pediatrics Rotation Update: Weeks 3-8

For the peds rotation proper, I spent 2 weeks in the NICU, 2 weeks in Vandy’s acute outpatient clinic, a week on one of the general inpatient teams, and a week in the newborn nursery.  I think I might be able to put all of my highlights from this rotation in a single post this time.

  • I really enjoyed being in the NICU.  I rounded with the two residents, the NICU fellow, and the attending physician, as well as the NICU nurse practitioners.  Most of the babies in the part of the NICU I worked in had issues such as prematurity or respiratory distress syndrome.  I liked the fairly structured environment; we presented patients in a very particular format on rounds, and there were a number of protocols to abide by when determining plans for each baby.  I also accompanied the team for deliveries and c-sections, so I feel like I got a bit of OB/GYN experience too.
  • On outpatient peds, I saw tons of kids with fevers, runny noses, and rashes, but I also got to see a few less conventional cases: for example, a kid presenting with abdominal pain, diarrhea, and weight loss; and another child who complained of horrible leg pain with no apparent cause.  Some days, I didn’t get to see many patients because the majority were not English-speaking, but on others–like the “Residents’ Day Out” when the majority of the physician workforce was off for the day–I was constantly moving from 8:30 am until the early evening.  No matter what, the house-staff were always willing to teach, even if it was a busy day in clinic; I felt that I was studying even when I wasn’t actually “hitting the books.”
  • I was assigned to an inpatient team that, unlike other teams, admitted patients from private clinics and from Vandy’s acute care clinic.  The Vandy attending would come in to round on her patients, and an attending from another hospital would also be there in the morning to see his patients, but I never met the attendings from the private facilities because they came in to round on their patients later in the afternoon and were mainly updated on patients’ progress by phone.  This team also had no interns, so upper-level residents put in all the orders and made all of the phone calls after rounds.  Because of the nature of this team, I was able to receive more responsibility; during that week, I pre-rounded on 2 or 3 patients at a time, accompanied the Vandy attending on mid-morning rounds, wrote progress notes, updated the team periodically throughout the day, and even made phone calls to other parts of the hospital.  On this part of the rotation, I definitely felt like “part of the team,” able to contribute to patient care instead of just standing around.
  • During my last week on pediatrics, I spent 3 of my mornings in the newborn nursery with 3 other students.  Our basic task there was to learn how to do a head-to-toe physical exam on a newborn–checking normal newborn reflexes, listening for heart murmurs, making sure there were no deformities such as dislocated hips or fractured clavicles, etc–and present our findings to the rest of the team.
  • The 4th morning of our last week, we rounded with the NICU team in the Children’s Hospital.  This was not the same unit that I spent 2 weeks in; in the VCH NICU, many of the babies have more complex syndromes or have required surgical intervention–in fact, some of them spend many months on the unit instead of going home soon after birth.  We only spent a few hours there, but I feel like we learned a lot from the experience–especially since one of the attendings stole us from the team and taught us all about the causes for cyanosis in newborns!

That pretty much sums up the rotation.  At some point during this 6 week stretch, I realized that the majority of kids that I had taken care of had been under the age of 1 year.  I keep wondering if this is a sign that I’m going to end up doing neonatology.  As a matter of fact, my interest in the medical field first became a reality in the 9th grade, when I did a report on infant mortality.  It’ll be interesting to see if this focus on babies will come full circle in the end–for now, I’ll just say that I will miss working in the Children’s Hospital.

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