Yes, I'm still alive. Finished trauma surgery last week at full speed, had a whirlwind of a weekend seeing friends and holding their drooling babies, and I've just started inpatient pediatrics wards this Monday.

I don't have much to say about peds right now. I knew that I was going to enjoy being around the kids all day, and I do, however, my life has suddenly gotten much slower and smaller, and there's definitely some adjusting I have to do. I'm used to rounding on 20 patients in one hour, not on 4 patients in 2 hours. I'm used to trying to solve as many problems as possible in as little time as needed and in the most efficient/effective way, but I'm finding that that's not the way things are generally done outside of the surgery rotation.

For instance, in surgery, the patients are monitored after an operation by following daily labs and vitals for any signs of bleeding or infection -- common and treatable complication to surgery. There are strict guidelines on how you do this, clear signs that you look out for, and specifical physical exam things you check daily. In pediatrics, this is not alwasy the case. We don't take daily labs because we don't want to poke the kids with needles. We can't monitor their vital signs because they are usually put on Tylenol or Motrin for any little sign of discomfort. We don't x-ray their chest because the radiation exposure poses too much of a risk. So I find myself nervously watching my post-op patient coughing away with a wet cough, looking feverish, but not enough to count, and wondering if she's got some infection I should be taking care of.

I raised this issue with my team today, and after a few long thoughtful pauses among all the members and some more attempts by me to explain what exactly my concern was, my attending said that if the kid was really sick, she'd spike a fever despite the motrin and "just look like a sick kid". This was the best answer I have gotten so far. After spending two months on surgery, where every treatment option is backed up by evidence-based research and recent important studies are cited repeatedly by name, it feels a bit awkward to be told that I will "just know" when the patient needs my care. I respect my attending a lot: she is very intelligent, perceptive and experienced, and I have now doubt that she needs few medical tools to diagnose a sick kid. At the same time, I'm a little worried that there isn't a better system to pass this knowledge down. I had to go all the way up to my attending to get an answer to a question about basic patient care, a job that our interns and residents are technically in charge of. She did eventually let me order the CBC, but I'm still pretty sure that with or without it, I would need to follow her around for more than just a few weeks to gain the experience of sensing just when a sick kid becomes sick enough to treat.