With the cool kids (s/p Pedia)

First time doing a status post pedia! It’s been a good couple of weeks.

As someone who didn’t rotate face-to-face in pedia for clerkship, babies and small children were truly a mystery. I’m happy to unravel even a little bit of it. At the end of the day, it still boils down to care, compassion, and extreme effort to not pinch their cute little cheeks.

(This is a short life update post before I disappear in surgery.)

Quality over quantity

The census for the pediatric floors (not counting the PICU and the NICU) was only two pages long on my first day. That’s honestly one of the most disorienting things I’ve ever encountered in the history of ever.

It’s a far cry from the pre-pandemic days when pediatric patients would invade even the adult medicine floors, thanks to either dengue or a measles outbreak or just a really toxic season. Back in the clerkship-that-wasn’t, pedia duties in Osmak can reach an ER census of 120 patients per day, and rounds in PCMC (Philippine Children’s Medical Center) were apparently infinite. But here in TMC, mostly because of wary parents and this awful lockdown, most children are managed via telemedicine or on an outpatient basis.

What remains, though, are some very singular cases.

Though there will always be patients with systemic viral illness and severe dehydration (that is, a really bad case of flu that requires intravenous hydration and support), we saw cases that probably number in the 1:10,000 or even rarer.

Since the census was so small, and the cases so specific, I won’t go into too much detail. But it was just a blessing to see these patients and follow their stay, from the ER to pre-op to post-op to possible discharge.

**Featuring the iconic wallpaper and couch set in the pediatric ward.** We spent a total of three eight-hour shifts going around the floors. Special thank you to Doc Jian for taking the time to teach us!
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Little big emergencies

When it comes to the pediatric population, anything can be an emergency. Unlike adult patients who could walk around with a stab wound and still have the audacity to say “it’s nothing, don’t treat me, I just need pain meds”, most responsible caretakers for kids come in with the appropriate level of urgency. And maybe a little bit of extra.

In this way, the emergency room also sees a wide range of cases, from the truly benign acute gastroenteritis and muscle sprain, to the more obscure cases of extrapulmonary TB (who would have thought) and pediatric psych-related emergencies. The former would make you wonder why they couldn’t just do this over the phone or during office hours. The latter would push you to reconsider primary care and biopsychosocial health.

(Back in March while rotating in neuro, I even saw a case of adolescent seizure in this same ER).

Two eight-hour shifts in the clean emergency room can arguably teach more than two weeks of hitting the books. Or at least that’s what it felt like.

This is the part of the two-week rotation where I was able to interact more with patients. Even though we were a team of 1 ER consultant, 1 pedia resident on duty, 2 interns and sometimes 3 clerks (coming up to a ratio of 7 doctors to 1 patient!), there was still freedom to interview the patients, do various parts of the physical exam, and administer vaccines/meds.

Fun fact: just found out nurses aren’t licensed to extract blood et cetera for diagnostic work-up? Med techs have to do it. Or doctors, I guess.

A part of me is still mourning the loss of an OsMak rotation in pedia. What little I saw was so hardcore. :(

**With this case magnet.** Honestly my first shift in the pedia ER was so benign (we only saw three patients), but then I went on a shift with David the next night and suddenly I saw both quantity *and* quality. The only pitfall with our very generous schedule was that we had to sign off just as our last patient was being managed. It was a very interesting, if disheartening, case. ALSO: the same pair of interns who got a “not bad” from Dr Cheng after struggling to explain fetal circulation and the pathophysiology of Hypoplastic Left Heart Syndrome in the NICU.
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Really can’t stress how mind-numbingly cute or frustrating children can be! Even adolescents.

BABIES, babies, babies……..!!!

As one of the youngest in my family, I haven’t had a lot of interaction with babies. In fact, I am still arguably a baby at 25 years old. The much younger cousins or nephews I have are unfortunately either abroad or in a different island or sheltering thanks to the quarantine.

In other news: I CAN’T WAIT FOR MY NIBLING TO BE BORN LIVE TERM, BABY BOY, VIA NSD APGAR 9,9, AGA et cetera et cetera this coming August!!!!

I digress.

So the chance to be a NICU intern was something I cannot miss. And which I now miss. Bring me back please.

There are maybe two or three things I especially loved about my short two-day stay.

Playing with babies. It’s inexplicable. There’s just something precious about little babies. It doesn’t make sense that they grow up to be adults polluting the earth. Even when asleep, they’re cute. Their hands are too small. Their little abdomens stretch out as they breathe. They have the audacity to smell super baby-like when they’re freshly washed. Though I’m probably just saying this because I’m not responsible for the rearing and eventual tuition fee of these little monsters… At first, I was hesitant to play with the babies because they looked fragile. But they’re apparently tougher than I thought. And they also need the touch.
New skills! Not sure if I’ll ever put my new skills in newborn screening and BCG vaccination to the test in the future, but it felt satisfying to entertain and examine the babies that were rooming-in with their moms. They were ready to go home right after. (FYI: The Medical City doesn’t have a nursery, only a neonatal ICU; 100% of well babies and well mommies are roomed in with each other).
Continuity of care. Coming fresh from OB, I even saw some babies in Level III (the highest level of care in the NICU) born to mothers that we monitored and took care of during our OB rotation. You can really see how it can take a village to get moms and babies discharged well and improved.

Read: Last Woman Standing (s/p OB)

Not everything is perfect, of course. Some parts are too sad and too delicate to write about. But I just tell myself that the team has done and is doing everything they can. The rest is already up to chance.

**Levels I and II.** This area of the NICU is reserved for babies who only need some level of monitoring or advanced newborn care. (Level III involves subspecialty care and even more continuous monitoring and support.) You can argue that this place is as benign as my duty-mate Raph. During our eight-hour shift, we caught no babies. We essentially only did rounds plus some boards review. But thank you for being my senior pedia intern and for showing me the ropes.
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Sprinkle in some support and love

The setup for the pediatrics rotation is arguably the BEST compromise between learning from experience and studying for the boards. We really only went to the hospital for half of the week; the rest were spent on telemedicine and working on review. Each shift was only eight hours long, also ensuring time to rest, clean up house, and study again.

I count myself extremely thankful for the compassion and understanding of our pedia consultants and residents. These are singular times. Everyone says that we’ll make it and do well in our boards, but I don’t want to risk it!

Reasonable duty schedules are a love language.

And also food and zoom calls.