Life's Lessons: Best (and hardest) way to learn. AKA Strep Throat

So after 7 days of vacation (spent working around the house) I began work in the Pediatric ER at the county hospital. On my second 12 hour shift, I began the day with a four child MVC. 3 siblings and a cousin. Mom (aunt) was in the adult ER and these kids ages 6-13, give or take a year or 2, were all brought in on strechers with C-collars on. Before these collars can be removed, the c-spine must be cleared. That means that the attending must see and examine the child and loosen the neck brace and palpate (or feel) the vertebrae while keeping the head still and in alignment while asking the child (or adult) if there is any pain. If the patient says, yes, there is point tenderness, then x-rays must be done (with the c-collar FIRMLY in place) to rule out a fracture. I digress for my whole reason of this post, these 4 kids were funny, but time consuming.

THEN!!!! We got what we refer to as a five-fer. Often an exam room will have a two-fer; 2 patients for the price of one. Usually siblings with the same complaint and same parent who both need to be seen. It then becomes the job of the doctor (i.e. me) to sort out who has what symptoms starting when and how bad. 2 patients at once is never fun, but tolerable. So, back to my five-fer (which is kind of funny, my high school principal was a Pfeifer--She was GREAT!)
You'll see in a few minutes why my typing is irractic and wandering.

5, fünf, cinq, cinque, 五 (that's Chinese according to Google.com), cinco, FIVE children in ONE room (one TINY room) at ONE time, with their mother (who happened to be pregnant with #6)--ages 2, 3, 10, 11, 12. Guess what, they all had the same complaint. Sore Throat, nasal congestion with green drainage, fever.

Strep throat culture: positive in 2/3 kids tested.

So 3 shots of Penicillin for the 3 oldest. The 3 yr old had an ear infection so he got oral amoxicillin.

Now, you would have thought that I was sawing off one of the girls' arms with a butter-knife the way she screamed and carried on while I was giving her the shot in her "hip" (butt, people, it's the butt). I was in that one room for a complete hour seeing those 5 children. By the time I got them their shots and medicines and discharge paperwork, 5 hours of my undivided attention had passed.

That was Thursday.

Friday, I went to the church to help with some friends' wedding taking place on Saturday. I went out Friday night with the guys to Dave and Buster's and played video games.

Long about 10:30 p.m., I started getting a headache and, yup, my throat started to hurt. When I woke up Saturday morning, I had a 102.0 temperature and felt like death warmed over. I stayed in bed, missed the wedding, and finally broke down and took ibuprofen to help reduce the fever. It did and I began to feel slightly better. I did, however, have to call in sick for my overnight shift in the ER Sat. night-Sun. morning. It's the first time I've had to miss work or school because if illness in a LONG time (4-5 years).

The fever returned in roaring fashion Sunday morning about 2 a.m. I was up for 3 hours before I took some more ibuprofen.

Side bar: Fever is not a bad thing. Our bodies raise the temperature to fight whatever
virus or bacteria is attacking us. Bugs like their environment to be just so, not
too hot, not too cold. When you have fever, your body is trying to denature the
proteins that keep the bacteria or virus alive, thereby killing them and helping
you feel better. So ride out your fever: kill a virus or bacteria today.

But fever also makes us uncomfortable, VERY uncomfortable at times. So, like good Americans, we take medicine. My fever broke for the second time about 6:30 a.m. Sunday morning and I was able to get a few more hours of sleep. By this point, I was feeling somewhat better and now had no more fever, so I called and told them I would be at work yesterday for my overnight shift (Sun. 7 p.m. - Mon. 7 a.m.). I was feeling ok by the time I got to work. Early this morning (5 a.m. or so)...I felt a small headache coming on, so I took some more ibuprofen. Then, around 6:30 started sweating again. I guess I had some fever and didn't realize it.

So, I left the hospital this morning and drove straight to my doctor's office. She is the doctor that I saw throughout medical school and she works at Student Health. Since she's on my new insurance--she's a UT doctor, I can still see her. Well, she wasn't in clinic this morning, but one of my Pediatric Attendings that I had worked with in Pedi Clinic was there. She was slightly confused when she saw me. We had only worked together once, so she knew she knew me, but didn't think she had seen me as a patient before. It took her a minute to put it all together. We laughed. Before the doctor came in, the nurse had swabbed my throat for the rapid Strep test. The doctor came in, asked me when my symptoms had started and how they had progressed and then she asked me, "So what do YOU think you have?" Even when I'm sick I get pimped about diagnoses...and like a good intern I replied, "Strep Throat!"

I win!?! Yup, those 5 precious children in the ER had graciously shared their Strep Throat with me. I'm forever grateful, really. And I, too, got to experience Bicillin L-A in the butt, which is my whole reason for rambling (the title of my blog is Ramblings of a Med/Peds Intern) on here. Through this experience, I will never forget that to treat Strep Throat you can give 10 days of amoxicillin 3 times a day, or a one time shot in the rump (TAKE THE SHOT PEOPLE!!!!) and that the shot is 1.2 million units of penicillin. 900,000 units of benzathine penicillin G and 300,000 units of procaine penicillin because the procaine helps anesthetize the injection site. It's an intrmuscular injection and most of the time it hurts.

Now, life teaches us the hardest but best because I just typed all of that above without having to look it up in a book. I couldn't do that a week ago. And having experienced it first hand, it's a lesson I'm not likely to soon forget.

One more bit of education. We (doctors) treat Strep Throat not to ease the pain of the sore throat. That will go away on its on whether we give antibiotics or not. The reason we treat Strep is that, left untreated, it can lead to acute rheumatic fever. And Rheumatic Fever can lead one to become susceptible to bacterial endocarditis (inflammation of the heart, vegetations on heart valves, i.e. bad things that antibiotics can prevent) which could lead to all sorts of headaches. So we treat. And the lives of our patients (and even ourselves) are better.

I am still ill, and even though I just re-read this post to make sure that there were no typos (I found TONS) and that I made sense...it is possible that the fever is still clouding my judgement and I missed a sentence or 2 that is completely off. Sorry, I will go sleep now and feel better.

MD Anderson Cancer Center

I am nearing the end of my rotation here at MDACC. I am on call and it's 11:45 p.m. on a Friday night. Sadly, death is near. I knew kids with cancer would be hard to deal with...

So it's now March 6th and I'm just now getting back to this post.

I was right. Death was near, but it waited until I left the hospital. One of the kids on the floor died Saturday afternoon after I left. The human spirit amazes me. This child (again, I must be vague for fear the HIPPA police will find me and drag me into the streets and beat me. They won't, but violations are $10,000 apiece and I'm a little short on cash flow right now, ha ha)...so this child, near death, basically said that they were waiting for a parent and a sibling to get to the hospital. Other family was already there. When the last of the family arrived, they had about an hour's worth of conversation and then this child died. The fact that they were able to hold off death to see family has no medical explanation.

I was sad when I logged onto the computer Saturday night before bed and saw that death had come. I laid awake for awhile thinking about the struggles this family had had. And the paradox that they now faced. One struggle was over, but another began the instant the first one ended. I'm not a parent, yet, (hopefully someday though), but I can't think of anything worse than to sit at your child's bedside and watch them die; whether it be due to cancer, or accident, or anything else. Kids are meant to live forever...at least longer than their parents, right? So to lose a child after a lengthy battle with cancer...it was not lost on me that this family must now pick up, go home and learn to live again. And learn to live without their child. Hospitals get old, FAST. And kids with cancer are in and out of them all the time. An admit for chemo, stay a few days, go home (which is more than likely the Ronald McDonald house or a nearby apartment because kids at MD Anderson come from all over the world for treatment) come back because of fever (which is VERY serious after you've destroyed all the body's ability to fight infection), stay a few more days. Get blood, take pills, get woke up (is that proper English) every 4 hours for vital signs, have a whole host of residents, nurses, pharmacist, nutritionist, child life specialist, nurses, attendings, medical students, other cancer patients, volunteers come into your room at all hours of the day and night. It's exhausting to be in the hospital. A nurse once told me that the hospital is no place to sleep. If a patient wants to sleep, they should go home. Hmm....

So now that routine is over for this family and they must go home and try to understand what their new reality is. It takes time. And it takes time to live again. Beth and I just went through the motions for ? months ? after her dad died. I can't even really tell you how long it was. It's all very fuzzy. Which I think is the brain's way of helping you, us, me deal with such tragedy. I will think of them often and I pray that God will help them find peace quickly, so that they can continue being parents, aunts, uncles, brothers, sisters, sons, and daughters to the family around them.

Anyway, enough rambling. I need sleep for my last day of vacation that I will spend dealing with the builders who built our home and his crew that seems to have damaged my sprinkler system as they were building the house next door. This should be fun. I'll let you know how it turns out.

On Vacation

So I am officially on a week's worth of vacation. Now, I could use this as an excuse NOT to post over the next 7 days, but since I haven't posted since Valentine's Day (as some of you have pointed out) this excuse probably won't hold much 9% Normal Saline (lame attempt at medical humor...are you even thinking about laughing?)

So, I will post tomorrow, maybe. There is a post that I started on the 24th while on-call that never got finished because there was a constant stream of issues on the floor to deal with. Not to mention the fact that the code pager went off a few times....more on that later.

So tomorrow it is.