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Wednesday, November 17, 2010

i have learned a thing or two~ pediatric pulmonology



Image at: columbusparent.com

I finished my 5th rotation a couple of weeks ago, and it was by far the most challenging rotation of my P4 year. Here's a snapshot of my time at the Children's Hospital.
From day 1, I quickly learned that I would be expected to follow ~15 patients with the pulmonology team each day. It was my responsibility to go to rounds and be ready to answer any question the attending doctor, attending fellow, residents or medical students had about the patients. 

 Image at: theage.com.au

Which antibiotics is little Bobby on? Are they appropriate for what we are treating? Can he be on P.O. or does he still need IV? Does he need a PPI? What is the dose of Zosyn for a 14 month old, 15 kg baby? What is the motility dose of Augmentin? Does little Haylie need one or two flu shots this year? Is her pain medication adequate? How much PRN did she use yesterday? Should we increase it? To what? Does she have Miralax on board to prevent the opioid induced constipation? What are her allergies? Did CJ have a bowel movement yesterday? Was it large? Do we need to HOLD his Vancomycin due to the most recent levels? How are his kidneys? What are his Ins/Outs? Let's have a look at the Chest XRAY....

 Image at: healthguide.howstuffworks.com
And the list goes on and on.

It was so intimidating initially to be the go-to person for the team of DOCTORS?! I wanted to say, "HEY, y'all ummmm, ehhhh, I am just a pharmacy student. To-be-sure, you aren't depending on me for all this?" But, they were! I was surprised at how heavily the medical team relied on the Clinical Pharmacist and her two students for the entire month. It took me about two weeks to even trust my own recommendations (without looking them up twice and verifying first before saying a word), but after that- I hit my stride. What a wonderfully, satisfying feeling. To truly realize that, "WOW, I have learned a thing or two the last 3 years". :)

It was a change for me to work with kids and babies.....my heart could barely stand the fact that all these beautiful children were there because they were very sick. We had two patients in particular; two sisters, ages 3 and 5, with beautiful hair... so blond that it looked white....they were both admitted with cystic fibrosis exacerbations. They ran around their hospital unit in the sweetest yellow PJs with their hair flying. I watched them laugh and play and prayed that a cure would be found for cystic fibrosis in their lifetime, please......

My next to last day there was the most challenging.

A week before we had a little 17 month old baby admitted with altered level of conciousness; I looked at his medical record and read the saddest birth story ever. He was born to a 15 year old mom that had premature rupture of membranes. Her water was leaking for 8 days before she told anyone about it and went into active labor. At delivery, the baby was born in respiratory distress and having seizures. His prognosis was not good.

17 months later...he was admitted to the pulmonology unit to see what was going on. His electrolytes were a mess, and he had signs of infection. He was given a certain medication that could potentially worsen this. The medical team asked me what to monitor, what to expect with that drug, how long will the drug be in his body.....etc....I sat there scared for the little guy because clinically he was failing. Please, don't let him suffer.

He fought for a week as many medical technological advances helped him hang, but finally his body couldn't fight anymore. His family had to make the tough decision to let him go...he was technically brain dead.  Several head CT scans showed cystic brain (essentially just fluid) where normal brain matter should have been. An abdominal scan showed massive infection despite being on 3 different IV antibiotics. Nothing else could be done. His sweet soul went to rest the next to last day of my rotation.

It was a very trying month on many levels. Physically, I did not get much sleep. It was all one big blur quite like the newborn days from way back when.  I had to be there before 6:45am to have time to work up all my patients before medical rounds at 9am. I also had homework/projects/research to do at night when I got home. I logged >250 hours for the month. Do the math. That is just pure insanity! Academically, I had to function all on cylinders. They expected my very best, and that is what I strived for each day. At home, everyone suffered. Laundry wasn't done. Housework fell behind. We ate too much take-out. Chris tried to take up the slack. I am not sure who was more relieved at the end of the month, them or me! No sacrifice, no gain, right?!

This month, I am OFF. YAY! Next month, I look forward to the being at the VA Ambulatory Care Clinic. It will very different from last month, 95% of the patients will be (cranky, old)  men! I am looking forward to the challenges it will bring as well and praying that it will afford more work/home/life balance. One month closer.

And the countdown to graduation continues....

Satisfaction does not come with achievement, but with effort. Full effort is full victory.
Mahatma Gandhi  

1 comment:

Foursons said...

Oh wow, you had quite a rotation! I never dreamed that pharmacists had to know all that stuff. I mean I know they knew a lot but it almost seems like you are getting your MD.

Glad you got through it all and I am willing to bet that your grades and critques show it.

Enjoy your break!

Deciduous Heather