Well so much for keeping up.

The last few weeks have been a wild. Mostly because after a stint of nights in the ED follow by a month of the floor which includes a struggle to study for step 3 I just haven’t found the time to write or really do anything except work, study and sleep.

Doesn’t that sound familiar.

Yes, it really never ends. Studying for step 3 has really been a mess, and I know it’s supposed to be the easiest of the three. That being said, I’m not a great test taker for a multitude of reasons and I’d rather be tired and safe than lazy and out close to a grand. Plus, a lot of it is a good refresher since a lot of medicine I haven’t and maybe won’t see since I am pediatrics, after all. It may be the only time I’ll be jealous of anyone who works with adults. But after this, I will be thrilled to just stick to peds.

I returned to the floor at the second week of February in such a strange state. I was having that same feeling when I was NICU after my previous floor month, since I was tired of just doing okay. I believe in a previous post I had mentioned working with our hospitalist fellow on improving the area I was weak in, which was presenting. And it worked. A lot. Just like NICU, I improved so drastically the attendings didn’t really understand how or why. It makes me feel a variety of things, mostly disbelief. But the good kind.

In a strange twist of the month of figuring it out, I also recognized sick patients  much readily than ever before. No one tells you as a medical student one of the must crucial things you learn as a resident how to tell if a patient is sick. It may seem that something of such a important caliber would be obvious, but really it’s not. It’s subtle signs. It’s knowing what’s normal and what fits in a story. It’s trusting a feeling and figuring out why you’re having that feeling. It’s things you only learn with experience.

And somehow, I was able to identify some patients who needed higher care, in the face of attendings who thought otherwise. The first was respiratory children, as in more than one, yes. Respiratory issues are bread and butter peds; asthma, brochiolitis, pneumonia, etc. So the idea I knew the basics well enough to know it was bad enough made me fairly proud of myself.

The other was a little more complicated. I got the call around 2:30 AM near the end of the my two weeks of straight nights. Floppy baby. Who had not previous been floppy and was old enough to be able to sit up and stand up. No one in the emergency room was super concerned, he was sent by his primary because he thought this kid ought to be admitted. And so it was.

I was immediately nervous. I hadn’t even seen this kid yet, and I had seen enough “off” kids with weird meningitis no one was initially concerned for be worried. And it turned out to be botulism. Actually, real life, neurotoxins via spores. And the ED doc was going to send them home. The moral of the story is milestones are very important if you’re going to be working with kids at any point.

I’ll be starting nursery on Monday, and we can only hope it’ll be better than the nursery has been. Hopefully.

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