Where did 9 go?...7 "ate" him

Rotation 7 is finito! I am going to miss peds. I think I found my nitch. I didn't drop any of them. I didn't kill any of them. And I may have made a difference in one or two of them. Joy!
Although I am sad to see 7 go, and wish it could eat eight not nine - but that's not how the stupid joke goes - I am ready to move on. only 3 to go - 2 rotations and a microphone (aka graduate project). I'm ready to pack, typhon, homework and culminate my presentation for PPS week (which I am sure everyone is just super excited for..like myself).
I'm coming home honey...I'm coming home.

Ethics and Morals

I find very few times when the phrase "I highly encourage you to revisit your moral or ethical values" is appropriate. And just for the record - yesterday during a phone call was not one of them. Nor do ethics need to be religious-based, yet another inappropriate component to the same phone call. And finally... there is nothing more annoying then someone who acts like they care but there voice and tone is completely different (had it not been a phone call maybe I would have had a different feeling) and please don't act like you have a clue if you are coming into the middle of a situation - like the middle of a movie, or a conversation or perhaps a clinical year.
And PS - if you are going to paraphrase my words, be accurate and true to what I am saying don't add in your own words to completely misconstrue the original meaning - and I don't like your condescending demeanor so can it.

7 week save

I helped save a 7 week little girl today - well yesterday but the fruits of my labor paid off today.

7 week female into the office for a rash on the right cheek. Mom reports a "fever" of 99 under the armpit and added a degree to call it 100. I explained I was glad she came in although we don't usually get to worked up about these "fevers" unless they are 99.4axillary or 100.4 rectal. But glad you brought her in to be on the safe side. I thought her rash was bad irritateed ezcema that they'd been using the horrible baby magic on and some wicked seborrhea. She looked nontoxic - smiling cooing, eating ok, sleeping ok. My preceptor thought the rash and ear looked impetigo and yeasty so we attempted a culture of the front part of her ear. So with this feverthing - do you work her up because she is less than 2mo? or treat her rash once the culture grows out. It was my call... so I said draw a CBC, CRP and since we're sticking her a blood culture thinking if we're going to the trouble might as well go all the way. Her culture came back on her ear - yeast so a little lotrimin cream to the cheek. This morning though her blood culture had already grown streptococcus which means she has bacteremia - bacteria in the blood. SO she needs to be admitted and have an LP. So she comes into the office for a cath and LP. Long story short her LP CSF had >10WBCs (bad new bears...+meningitis) and Group B strep and another strep unknown still pending so this is one sick sick kid. Theoretically for as sick as this kid is and had the cultures not been done, just the CBC and CRP which were essentially normal - yes normal.... she most likely would have spiked a temp tonight and seized and then died or been brain dead from the extent of the meningitis and brain edema. That is really scary to think about. if I would have been on my own in clinic...would I have ordered the lab with the questionable temps? She was afebrile in the office without motrin on board and didn't appear sick. her rash is gone today and she still looks nontoxic. She's the kind of kid who would've crumped...just like that crumped. Needless to say it scared me enough that I will be a little lab-happy and jumpy for awhile. I know it's an expense and pain to the patient but if I ever doubt myself and lose a kid - I would be devastated. But for today I am relieved 9although mom wanted kiddo to be admitted to Children's which is a half hour away - which was before we knew what her LP showed and after 2hrs she still hadn't shown up with the id even though we were adamant that she had to go straight there...so I pray she made it). So like I said - for now, I say today - well yesterday...I helped save a 7week little girl - now the rest is up to something bigger than me.

Personal dermatology

So last Friday I once again came down with a horrible cold which I actually think is just an ongoing sinus infection (for the last 3weeks) with the headaches and sinus pressure - but what do I know - I'm not a doctor and try really hard to not try and diagnose myself. Regardless I am miserable again.. c'est la vie in the life of peds. But today I have a wicked rash - an erythematous, punctate rash with white circular halos around each lesion - translation - i have red bumpies that itch like crazy with white circles around each one, on my upper legs, on my shins and now on my one side and my arm. I have no clue what it could be - a viral rash? Some crazy thing I picked up on Friday? - I had 2 tiny little spots on my leg yesterday but attributed it to dry skin and put a little eucerin on my legs... and today lots more bumpies... AHHHH! Sickness = no homework para me. Tonight I am desperately trying to do homework but no luck. I like to watch a movie I know really well to just have on for noise but don't have to actually watch because I know it so well...there are no good movies on like this tonight so...I am watching Pirates of the Carribean....en espanol. No es lo mismo pero me ayuda con espanol, pero no puedo completar mi tarea. The commercials are even different like Angel soft toilet paper - at the end it says: an ideal balance of softness and strength in a cute little sing song - but in espanol translated: the toilet paper with ideal balance. Just not the same. Ok well I guess If I am going to watch Pirates I may as well actually try to understand what the hell is going on - I don't know the dialogue quite as well as I thought I did. Although killing pirates is the same in any language so all is good.
Adios hasta manana

Great Clips

I did my first snip and clip today - it was awesome!! Actually it was very very nerve racking-and in the end it was awesome. Whomever dreamt up that little contraption was a genius (and nuts!!) - I just want to know who volunteered their little boy to try it out. And I will never look at safety pins the same again. What a truly intricate and delicate process and yet barbaric all the same - very strange. I'm not sure if I was more nervous putting the block in and praying I hit the right spot- studies have shown that blocks are incorrectly placed a good percentage of the time and are therefore ineffective. My preceptor made one joke with me today when I was too nervous to do the whole block myself without seeing it done first- I'll do one half, you do the other he said - then we'll see who did theirs right. The kiddo didn't sleep through it but didn't fuss during the "painful" parts - only when he lost his sugar water binky -so my block worked. I wish I could invent some little tool to help ensure all the remnants after initial detachment are actually gone before detaching the contraption itself - I think I was more nervous about the scalpel slipping and stabbing the little guy or my finger as I "cleaned the edges" of any leftover debris. Here's a website if you're dying to read more about it and see the procedure. I had never really thought about what we;ll do when we have kids and if we have a boy but I've had 2 little boys ages 3 and 7 who were not circ'd at birth and have had massive infections because of it and had the procedure done at those respective ages - bummer. http://www.intact.ca/vidintro.htm. All in all after all was said, done, snipped clipped and bagged as a souvenir I thought, that's a good looking circ - I think he will appreciate that later in life.

In other non-circ news - Creighton isn't dancing this year - they were robbed of their dancing shoes hopefully they don't blow it in the NIT - although they came darn close tonight against Bowling Green. sheesh.

The Potty Dance

So I am watching Discovery health channel tonight as I am diligently typhonning and on comes a commercial for the potty dance I have never been so frightened in my life by a commercial so I just had to check out the website www.thepottydance.com and was even more frightened by the sketchy people in the background of this pseudo-rap video about doing the potty dance... see what you think for yourself (the old guy with the short running shorts and the creepy guy with the gloves - makes me think that these older people in the video who by the way are mostly men are not potty trained themselves). I will never think of hoolahooping the same again.

9 and 12

It's like football, sort of, 9 days of actual clinic, 12 days until I am home (or where i put my hands when I drive). Hell yes!

1. I am really loving peds. I had a patient tell me something really great today, it totally made my clinic day. I admitted someone today and some parents are looking to me for parenting advice instead of my preceptor who A. is the doc, B. has kids of his own C. has beein doing this for almost 20years... scary - I guess everone assumes I have kids or assumes I have a clue when I talk to them - not sure which is more popular (and I had to inform one teenage mom today that no I did not go straight from HS to graduating med school - but thanks for the I look young compliment)

2. Shawn and i just discovered video IM chats on yahoo - I knwo there's skype - but we're still old shcool I guess. When he figures out his microphone then maybe we can move up in the world. Why didn't we think of this like 6months ago - best thing ever! (except that I get so giddy being able to see hom and the doggies that iIneed to unwind before bedtime and listening to my favorite tunes doesn't help.)

3. tomorrow's Tues - my favorite day!

4. my hippo still smells like Shawn - ahhhh, smelly hippo.

5. tomorrow is St. patty's day - I have the perfect outfit picked out - well no not really just one of the two green sweaters i own and a pair of green socks with monkey faces and rainbows on them. (should this be combined with #3?)

6 - if needed...Our tuition isn't going up for the last 3months of school - what a novel idea!!! I sent a personal thank you to Pacific's president.