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.