Clerkship Diaries: Week 7 in Inpatient Pediatric Wards

Week 7: Inpatient Pediatrics


*DISCLAIMER: there is no medical advice here, my primary role is a medical student who's learning and not a writer, patient details have been changed to respect privacy*

Hi friends! Weeks 5 and 6 were lovely, I was on an elective that gave me space to explore community-based resources for some of my patient populations. It was a wonderful two weeks, and I feel more connected to the city of San Francisco, more aware of some the nuance and details around the issues of homelessness that affect my patients. It was a real treat to be in charge of my own schedule during the elective, something I don’t take for granted (especially as I gear up for my medicine and surgery blocks). I also had some time to go home – I visited Athens for a day where I met up with old college friends and saw the university through my sister’s eyes, and then I spent two days at home with my wonderful parents who are just the best people ever! I wrote almost every day, but most it was creative stuff that I’d rather not share. I’ll get more comfortable sharing my creative work on the blog one day, but it’s not today.

This week, I started on the pediatric inpatient wards at Mission Bay! It was kind of random but apparently a few SFGH peds folks get put at Mission Bay for their inpatient block – the commute is a little trickier but there are SO many patients with all kinds of conditions and backgrounds. SFGH is a lot of bread and butter cases, Mission Bay is mostly zebras. So it’s an interesting contrast. The campus is also beautifullll, with all these glass buildings and colorful buildings and wide open spaces and perfectly manicured courtyards. There’s benches without dividers, but there’s no one sleeping on them which makes me wonder if the hospital is unfriendly to folks living on the street because I sleep people sleeping out the general almost every day.






Monday 2/18:

I’m having one of the most manageable periods EVER

I took the best 1 hour break for shopping and some boba

I also worked out on my period and had a successful meal prep haul




Tuesday 2/19:
It’s my first day on the team and during rounds, I can feel the blood seeping out of my pad and into my underwear. I thought I had timed my change of pad well but rounds went over by an hour, and I didn’t know where the bathroom was and I knew that if I stepped away from the team I’d have a hard time finding them again.

During the day, a low-level roiling of my uterus was my background noise. An occasional sharp twist of pain or the slippery sensation of passing a clot. My energy was low, there were moments I knew I should have spoken up or made conversation but I couldn’t bring myself to. It wasn’t nearly as bad as usual though. I wasn’t doubled over or wishing I was curled up in bed. I was functional though not at my optimal performance. First days are always a little overwhelming, with a whole new world to take in. I think it will get easier. I hope my period does too.

Today was the first time I looked at a patient in bed and wished I was in their place.

I stayed for night call so I could get it out of the way for the week. The evening was nice, the team was so friendly. I wish I had more energy and could have been more present. At one point, the senior was about to dismiss me but then it looked like he felt bad for trying to leave me and suggested I stay with them. I had no background on either of the patients we saw next, I didn’t know even know what ward we were in. It’s interesting seeing a patient for the first time as a blank slate and just trying to observe them. Both of their parents were a little fraught. I wanted to ask both moms how they were holding up but I was afraid of opening up floodgates.




Wednesday 2/20:
The walk to the Parnassus shuttle stop was nice, and I even got a spot on the 7:20 which was unexpected. It was nice to get my FCM case squared away, and I had an interesting case to share with my classmates. The first lecture was a little long but I answered a question because I felt bad that no one was involved (people are so BOLD skipping class so early in the year omg), the second lecture was super helpful and engaging. I went to the feedback lunch (which was delicious), and everyone appreciated my suggestion for putting a break in our two hour lecture (let’s be real, my attention span is exactly 50 minutes). The afternoon small group was super engaging, I love that our small group facilitator really pushed us to the next level and asked us to defend what we’re saying. To not just say something but to know WHY (what’s the mechanism) and then the next step is to know what to do about it. He also called me out for having commitment issues and TBH he’s kind of right, there’s a reason I haven’t really dated anyone yet, it’s kind of scary and daunting to attach yourself to a person who might not be what you’re hoping them to be.

Anyways! I got to catch up with Hallen (ASW is going to be so different this year) and then called Jaaie (after some minor difficulties lol) and then had a really nice conversation with dad who was at home alone and then talked to mom too and even got some work done! Tomorrow is gonna be an EARLY morning but just tomorrow and Friday and then things get better phew!








Thursday 2/21:
It’s a Thursday that’s really a Wednesday. I woke up at 4:30 so that I could work out and then have an hour for transit, I’m not a huge fan of hurrying up and waiting for shuttle (hurrying up and waiting is a key component of many medical specialties, I've learned). So I was little tired this morning, considered coffee at one point but got through the day without it! This morning I spent way too much time pre-rounding on my first patient but hey it’s my first time I’ve pre-rounded on this service (let me say once again that Apex is gorgeous wow going from NICU paper charts to this is a GLO up). Morning conference was great actually, a conversation about cyanotic cardiac disease that I was really able to keep up with thanks to a session we had with Adam like a month ago! I took a little too long on my presentation at rounds, I forgot that we had a schedule to stick to and I was the first patient so I threw us a little off but then we caught up just fine!

Family centered rounds is interesting, I like that it keeps us grounded and reminds us to use language sensitive to our patients, but like what pronouns do I use (yous or shes??), how much of the assessment do I dive into without stressing them out about other possibilities that they definitely don’t have? Rounds went until a little after 12, we were 30 min late to grand rounds which was not super relevant for me but I had a yummy lunch and it was a chance to kind of turn my brain off for thirty minutes. In the afternoon, I was mostly on the hunt for tasks. My patients didn’t have a lot going on but the afternoon filled up with resp checks and med recs and progress checks. We took a break for TK rounds named after Tim Kelly who was a pediatrician at MB - once a week we sit down and eat snacks and talk about whateverrrr is on people’s minds, we also went down to the gift shop to buy some stuffed animals for our patients we thought might especially need them. It was a nice moment to say that I was affected seeing a really young patient who --sorry redacting this part for patient privacy--.

Ooo my nose is a lil stuffy and I might have a headache, I hope I’m not getting sick!








Friday 2/22
I had this realization this morning that I am probably one of the happiest people in this hospital. The patients and their families have so much to worry about, the interns and residents are seriously overworked, all the other folks who work here have do REALLY hard work with real consequences. I’m just here for my own learning and to pop in with a lending hand every so often. I don’t have real-world responsibilities, I don’t have to worry about grades. It doesn’t matter if people like me, the vast majority of my mistakes or oversights don’t hurt people. I just have to show up as my best self I can bring that day. I mean obviously I hope that everyone in the hospital that I’m walking past in the hallways are happy, but it’s good perspective for me to step outside myself and remember how small my stresses are in the grand scheme of things.

I had a moment on rounds today where the interns got an important update about my patient and I didn’t (I don’t really get any updates). It was a really hectic day so we were breezing through patients which is totally fine, but there wasn’t much space for teaching. I just had tiny moment of disappointment (frustration?) where I felt like I wasn’t part of the team, I wasn’t able to help with important tasks, I wasn’t worth keeping in the loop, it was easier for the interns to do things than to show me how to do them. I didn’t take any of it personally which feels like a growth moment (!) but being useless is like my worst feeling. Melanie, one of the interns, was so gracious and picked up on the slight change of my mood. She kept walking next to me to explain little details here and there, I told her that I felt like I wasn’t helpful but she said that I’d be super helpful tomorrow when I come in as the only person who’s been with our patient list all week. That made me feel so much better and was great motivation to keep my attention up during rounds. Later, Melanie made multiple efforts to give me feedback on my presentation (which was super specific and helpful and validating). She went out of her way to make me feel like part of the team, and it’s something I want to do when I’m an intern.

I also realized today that the difference between our senior resident and intern is pretty much the same difference between the interns and me; it’s not quite the same, but all of us are two years apart in our training. I lump all the residents together in my mind but it’s a helpful reminder that growth happens really quickly and that I’m going to be there one day (one day!).

Rounds went over time, conference was actually pretty interesting so it wasn’t quite a break. When I got back, I had a few tasks. There was an ED admission that Archana from H&S was the lead on, she asked me and the intern questions appropriate for our level and I was able to answer mine well. I get excited going down to the ED. I like that feeling of not quite knowing what’s going on yet and having to figure things out a little, like there’s a bit of mystery and challenge. I think there’s mystery and challenge to the minutiae of planning patient care over the course of a week but working up a patient just feels different. I’m trying so hard to stay unbiased and super open to all the possibilities of third year!! But I can’t help that I love being in EDs! The admit was super sweet and his mom was really thankful for us being there, I hadn’t seen a case like his before so it was lots of good learning.

There was so much to do this afternoon that signout (which is usually at 5) didn’t start until 5:30. Both the interns tried hard to dismiss me earlier but I had to stay for signout so I would be ready for tomorrow with the new team. We spent an hour discussing patients! I left the hospital right when the gold shuttle was leaving too, so I spent twenty minutes at the bus stop doing UWorld questions (which was actually pretty productive). I also saw two classmates briefly which was SO lovely and unexpected. I didn’t get home until a little after 7:30 and a girl was falling apart. I couldn’t even journal (this entry was written Saturday)!! I grinded and studied for shelf though!

It was day that was so hectic that I didn’t really have time or space to process. At least I got to wake up a little later the next day (I slept in to 5:40).








Saturday 2/23
I started crying in Target, rolling my cart down the aisle in search of peanut butter. The magnitude of what I’d seen all week was starting to hit me. One of my patients is the sweetest kiddo with the sweetest family and they might (probably) have cancer, and we haven’t really prepped the family for that conversation yet. Another patient has chronic pain refractory to all our treatments, and it feels like nothing we’re doing has really helped, it feels like they’ve only gotten worse since being here. I wonder if we’re responsible for it. One our patients has a super rare and super tough progressive genetic disorder; the pain is so bad that they’ve been on so many opioids that they’ve started on regular methadone, they need steroids to ease the inflammation but those make them sick too. They love to draw and they’re very good at it, I wanted to see if we could get them any materials to draw with but I didn’t know how to get in touch with child life and we had a zillion more pressing tasks that needed to be done today so I never got her some art supplies. One kid is just boarding in the hospital waiting for their foster family after CPS had to separate them from their parents. An adolescent who’s SO on top of their meds, has such a great sense of humor, is in here for moderate rejection of a transplant. We’ve seen kids with serious and incredibly rare genetic disorders, kids with severe developmental delays, kids tethered to the wall of their rooms with tubes, kids with drains and pain and uncertainty. Parents who listen to us without question and parents who reject our treatments, parents who are too worried to get discharged and parents who can’t wait to see their kid out of here, parents who ask good questions and hold us accountable. It’s great that all of our patients have advocates who support them, love them, and take care of them. It’s hard to believe that this is just a cross section of a single service.

I have to remind myself that this isn’t normal. At the hospital, in the pediatric ward, we see some of Northern California's sickest children. The vast majority of kids are happy and healthy, like the ones in urgent care and nursery; just a few are this sick and that’s why they see us. At the moment, I have a hard time remembering what a healthy kid looks like.

I was operating at like 75% today. The URI and headache were rough all day, I had to pee so bad twice that I almost peed myself. I’m so congested that I’m having a hard time breathing fully. I was alert and with it when there were moments I could help in. When I was being passive, I definitely zoned out. I had a rough start- I took an extra 10 minutes on my workout after sleeping in an extra 10 minutes, I ended up getting to MB right at 7 but I had some parking hiccups and then forgot my badge so I was 20 min late to sign out BUT I had only missed a few patients. Still I don't like the feeling of being late.

We starting rounding early (instead of pre-rounding -- which meant no pre-rounding!) because the team was small and the census was big, our attending was wonderfully proactive about that! Things really took a while though with each patient, we were moving pretty slowly (but surely!!). We didn’t finish rounds until 2 and we started at like 8:30. I think I was able to interject helpfully at many points since I had seen these patients all week while the two residents and attending were new. There’s so much I still don’t know how to do, so much I don’t even know that I don’t know about. I blew through my afternoon tasks, sending out pages was really fun and all of the consultants I talked to were SO nice and patient with me and understanding, even if they couldn’t be super helpful for our patients. The senior resident Kavita was SO nice and tried hard to get me out early, she dismissed me a little after 4 but then I swung back to answer one patient’s dad’s question and the attending saw me and gave me tasks and I just felt awful that Kavita thought I was disregarding her efforts to let me out early, and I was feeling sick and ready to go. But we did some chart review, I followed up on some physical exam findings and then I hinted again and Kavita dismissed me bless (I really hope our attending doesn’t think I was slacking today).

On the way out, the parking gate was UP so I didn’t have to pay for parking today WHAT so nice (they probably figured if people are in the hospital on a Saturday night, things are rough and free parking might brighten up people’s days?). I drove to Sprouts in Daly City (only took 16 min!! Gotta love the highway when there's no traffic) and talked to Jaaie on the way, I was a little tired while grocery shopping and then had to follow up at Target with items I couldn’t get. I had a nice phone call with dad on the drive back. I’m really drained right now but I think this will get easier.

Looking back on this week – I’m really proud of myself. I worked out every day despite being sick and being on my period. I ate pretty healthy (just a FEW workroom snacks) but I prepared my meals and snacks well. I got at least 7 hours of sleep every night, sometimes 8. I wrote almost every day. I’ve been learning lots and I feel myself getting more helpful for my team.