Block 2: Pediatric Emergency Medicine
For the second month of intern year I was at the children’s hospital for Pediatric Emergency Medicine (EM).
So far I’d describe the growth in medical school as (retrospectively) feeling more passive than what I’m experiencing in these first couple of months of residency. The big learning curve, the experience of being an intern, it feels different, more active, in a really good but intimidating way.
I think this shift makes sense for a number of reasons
- I truly am responsible (with oversight) for my patients now. I’m the one placing the orders and communicating the results with my patients and their families. This was never the case as a medical student.
- I am finally only focused on the specialty I want my career to be in, and focused on trying to figure out what knowledge and skills I will need in the emergency department specifically.
- Being a resident is actually my job. Although I tried to think of being a medical student as my “job” as well, it still feels different now that I am actually getting paid and truly an employee again. I really love this.
- Studying feels different now; in a really good way. Now I’m focusing on the knowledge I will need in real-time, for the care of my patients, not for an exam or to get some numbers for an application. I am still figuring out what my study habits will look like during residency, but overall I am much more excited to look things up in relation to my patients than when I was more passively reading sometimes seemingly random things in medical school.
- Although I could definitely be an intimidated quieter medical student, there is definitely more fear underlying everything as an intern. This fear is more intense primarily because I don’t want to mess anything up for my patients. I think this fear is healthy and normal, keeps me humble, and I can stay mostly calm because I know in reality my attendings are closely watching everything I do.
I’ve written this multiple times before, but I’ll say again that one of my goals with this blog is to share the hard times and the struggles too, hoping that readers can feel less alone. This month I felt a shift in my energy. I mostly felt this change while I was at home, not actually during work. This month I felt the adrenaline and the novelty of everything start to calm down, and I felt more tired and more anxious than the first month. I am so grateful for my husband Dominic, because he always lets me talk things out, or sit there in exhausted silence, and everything I need in between. I think I was better this month than I have been previously about communicating when I felt anxious, exhausted, or overwhelmed. Some days I came home and did absolutely nothing, and tried to be kind to myself about this. I can feel my body asking me to be more active, so I tried to work out more this month, and I’ll keep working on this. I was really proud of the days when I turned around my anxious mood with walks, workouts, cleaning to happy music, some of my usual go-to’s. One of the things I’ve always struggled with is being forgiving of myself on the days when I can’t turn things around and I just need to rest, or need to allow myself to feel overwhelmed for that day. Again my Dominic helps me on those days by reminding me that it is okay to be anxious sometimes, just knowing that it will pass and that I can handle it. These anxious moments for me tend to occur outside of my actual shift; the weight and importance of what I’m learning tends to hit me once I’m sitting still at home, or in anticipation of my next shift. During my actual shift, I’m able to put any non-work-related thoughts on hold, and I think that’s appropriate, as long as I still allow myself space to work through the ups and downs later on.
Trying to put this shift in energy into words is difficult, but overall I don’t think it’s a bad thing. I think it’s really just my mind and body starting to settle in for the next three amazing but challenging years to come.
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Working in the Children’s Hospital ER was a really great experience this month! Examining kids is so different from adults, and I definitely gained more confidence in my exam skills just from repetition. All of the attendings and my senior residents were very supportive and patient as I still have a lot of intern-level questions.
A lot of my patient cases this month were “bread and butter” Emergency Medicine cases. In other words, I saw a lot of common chief complaints and presentations that are “classic” types of patients that I will see for the rest of my career.
- I saw a button battery ingestion, and also separately a coin ingestion. Swallowing a button battery is a true time-sensitive emergency because it can erode through the esophagus which can be life threatening. One thing that EM physicians learn is to look closely at the x-rays of button battery and coin ingestions, because you can often tell the difference between the two on imaging.
- There were a few cases of known appendicitis, and one we admitted for observation for possible appendicitis.
- I saw a few patients with what were most likely breath holding spells and febrile seizures
- I saw a patient who was diagnosed with testicular torsion and watched the surgery resident reduce the torsion. The patient described the pain with radiation into his abdomen, which demonstrated the importance of considering testicular torsion in my differential of abdominal pain.
- I got to reduce my first nursemaid’s elbow! I had reduced one as a medical student, but I didn’t feel the “pop” back into place. With this one I could feel it, and it was great to see the patient using their arm right away afterwards.
- We had a patient with a recent COVID infection who was now extremely tired, borderline somnolent, who we saw immediately in a resuscitation bay. Some of the first few things we start with as we examine patients are always: beginning the primary survey (airway, breathing, circulation, etc), and having the team hook the patient up to monitors, obtain IV access, start oxygen as needed, and check a bedside blood sugar. My attending was actually the one who verbally ordered a fingerstick sugar check on this patient, and the reading was above 500, and we were immediately able to consider a new diagnosis of Diabetes with diabetic ketoacidosis (DKA) as our primary differential. This was a classic presentation where a child has some type of infection stressing out their body, and then pushing them into their first DKA. Since this patient was so tired, I was checking on their neurologic status frequently as they awaited ICU admission. I asked my attending for a second set of eyes on the patient as they were so tired and difficult to wake up with just verbal stimuli. Watching how my attending assessed the patient was really helpful for my learning. “Kids sleep really hard” he told me, so we have to be more aggressive in waking them up than I realized as a new intern.
A majority of the cases I saw this month were related to COVID, RSV, or other nonspecific viral syndromes. The rise in COVID cases is overwhelming so many healthcare systems, including here in Corpus Christi, and that’s definitely a lot to wrap my mind around as I’m still new to the healthcare system. I think most of the people reading this are likely already vaccinated against COVID, but if you’re not, please consider it. If you have any questions I am happy to answer them or find the answers if I do not know.
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This month as I was able to see and discharge more patients, I can hear myself developing my communication style with my patients and their families. I am slowly getting more comfortable discussing test results, discharge plans, and answering questions. I had a few difficult conversations this month with parents and patients, and I think I handled them well. Even when I’m nervous, I’m glad to find that my baseline word choice and tone are professional, focus on objective facts, and focus on communicating what is best for the patient. It sounds odd, but sometimes I’m even surprised (in a good way) as I hear myself talking to my patients and their families. I’ve just never heard myself trying to be so professional, because obviously I’ve never been in these types of situations before. In my non-work life I consider myself pretty silly, I don’t take myself seriously at all, so it’s still odd and new to hear myself as a professional, as a physician in training.
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Tonight I start my month of night shifts back at the adult emergency department! I really liked night shifts as a scribe, and in medical school, and I’m hopeful that I’ll enjoy night shifts as a resident too.
I love reading your insight and experience! Thank you fir sharing.