My Youngest Patients

My paediatrics rotation issa wrap.

Although I have gotten to enjoy sleeping in more frequently and not having to be at the hospital at 7.30am, this rotation was more intellectually challenging and stimulating for many reasons. The doctors I had teaching me were all exemplary, intelligent and emphasised the need to impart the foundational knowledge of paediatrics. One of my tutors, my consultant doctor, was a paragon of excellence and a walking, talking, omnipotent encyclopaedia of paediatric knowledge. Throughout the entire five weeks, I don’t think she didn’t know an answer to one of my questions. She just knew it. Without preparation, without any reservations, she would provide you a concise answer that made sense. Kudos to my consultant for being GOATED during this rotation.

In New-Born Services, the emergency department (ED), Children’s Ward- the whole paediatric gamut of experience- all the paediatric doctors asked us medical students, “what do you think?”. Now, I’m seen, being heard and asked for an opinion? Surely there’s a doctor behind me.

I think it shows a few things. It highlights the interest that doctors take with teaching, and the lengths they go to make sure that medical students are actively involved in a team environment, because essentially, medical students are part of the multidisciplinary team. Additionally, it exemplifies the perceived expectations as a medical student and you don’t want to feel that you are interrupting or being a nuisance to a senior doctor, which after you realise the illusion of your student expectations, you become cognisant that they want you to bother them and take charge of your learning.

I found paediatrics to be challenging for another reason. The patient is not ultimately just the child in front of you. Albeit the child is unable to cogently communicate with you, it is essential to also assuage the parents too. I noticed that parents often come in and are worried about their child/ren, and sometimes they need reassuring more than anything. Assurance that they’re doing the right thing- both for new parents and parents who have gone through this before- and assurance that the paediatric team will do everything they can with their little babies. Additionally, when a patient comes in, you have to consider the environment and social context in which the family has come to the hospital. What specifically brought them in today? What’s going on at home? Does this influence the presentation of their complaint? And often times, the presenting complaint, isn’t even the underlying reason for showing up at the hospital initially. Nutting this out and slowly unpacking these issues does take considerable skill and manoeuvring, which I only just touched the tip of the iceberg.

I also saw a very interesting case of nephrotic syndrome. Nephrotic syndrome is pretty much a condition where you have significant amounts of protein in your urine, which causes generalised oedema all over the body. This young patient had all the cardinal symptoms of hypoalbuminaemia (low albumin in your blood), proteinuria (proteins in your urine, not usually normal) and generalised oedema (puffiness) that you would expect. I remember studying about this in second year, but actually seeing it on the children’s ward, ameliorates learning and consolidation. I examined the young boy, and it seemed with every identified symptom I was adding an infinity stone to my gauntlet of paediatric knowledge. Pitting oedema? A stone. Oedema of the abdomen, another stone. Low albumin and lots of protein in the urine? Why not, add some more stones. My gauntlet of nephrotic syndrome now complete!

The omnipotent consultant I mentioned earlier really did help me improve my paediatric knowledge and also made me reflect on my chosen path. On one of the weeks, after a tutorial, we were both taking the elevator and I was asked by the consultant, “why medicine?” The question of all questions; a question that all medical students grapple with, and any medical school interview station has this loaded question. Every time I think about why medicine, just as I did before my reply to the consultant, it reinforces and strengthens the pull of my calling. I told the consultant about my country. I told them about my puzzle piece of contribution to a better life for people who have known disruption, death and dissolution of life in their home country. And I told them about how we should be working toward a world how it should be, and not as it is, which is adequate medical access to all people. That’s my why in this pursuit.

Hope you’ve all had a wonderful month and have done something that strengthens your calling.

Back to the surgery wards for my next rotation!

See y’all then and eat those pancakes.

Anei :)