Clerkship Diaries: Week 8 in Inpatient Pediatrics

Week 8: Last week of peds!


*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*




Monday 2/25:


I was felt really good energy going in today. I had a great workout and made lots of snacks for the day, I left a little later than I had hoped but figured I’d catch up time on the drive. I parked at 5:57 and made a MAD dash to the shuttle stop, I could see the blue shuttle and when I was rushing to get on, the shuttle pulled away. I didn’t think twice about running down to chase it, I ran around the corner in my danskos (!!). Eventually I stopped but I could have caught up if I had known it was going to stop so long at the stop sign on 24th. One of the people at the shuttle stop cheered me on (“you go girl”), and I made a sad return through the shuttle stop to walk back to my car in the deck. It took me like 7 minutes to drive and park at MB, I wasn’t trying to pay extra for parking during the day, but I really had tried my earnest best. It wasn’t the best way to start the morning but I wasn’t all that winded, and I was there earlier than I needed to be. After getting myself a cup of hot tea, I went up to the workroom and started prerounding on my kiddos. I was hoping that at least one of my patients would be discharged on Sunday but no dice, they were all still around. After signout wrapped up, I had an hour to read consultant notes, check vitals and I&Os and labs, visit patients to ask about the night and do a focused physical exam! We also had 30 min after morning conference, and I felt really good about my pre-rounding! I did everything on my list!


Rounds ran longer than we expected (again), but it didn’t feel too drawn out. I felt the pressure to keep my presentations short and sweet, I want to show the team how much I’ve read up on my patients but there’s just not time! For some reason, the nurses were texting ME questions and updates about the kids – it’s funny because I felt left out on Friday for not getting these things; today, I felt like I was in a little over my head. I conveyed everything to the team and told the nurses to direct questions to our interns!! I can’t be responsible for these kinds of things I’m just a student! I feel connected to all the patients I’ve been following, I’m feeling some of the parents' distress, especially on cases that I feel a little unsettled by. There’s a lot of gray areas, there’s a careful balance between being transparent about what we know and making sure we don’t tell people scary things without having a full picture and being sure about our plan moving forward. I’m learning so much about wading through that nuance. It feels like being present and being warm isn’t enough. There’s not much we can do except wait for concrete results from other services; coordinating care across so many teams makes communication a real challenge and it makes it harder telling patients our updates with confidence. I just wish there was more I could do to make this easier on families, but we can’t stop bad things from happening. I hope we’re addressing them in the way that makes folks feel as supported and as heard as possible though.

After noon conference, we had thirty minutes (not enough time for the tasks I wanted to do!) before didactics that lasted two and a half hours. I was not prepared for that!! The chief resident asked the group for an interesting case, no one volunteered so I offered one of my patients and it was neat to flesh it out with a new set of fresh eyes. When I got back to the workroom, it was past 4. I got in a few tasks and lots of updates. I probably could have hinted to be dismissed an hour before I left but I was hoping to see a procedure that didn’t end up happening! On the drive back, I had a nice phone call with my sister and then my mom.





Tuesday 2/26
FCM day was off to a great start. I slept in until 6:30 (!!), got my workout in, had a leisurely drive to the clinic and got there just a few minutes after 8! The morning calm was so beautiful and I soaked in every bit. It was a slow day overall, not too many patients came in.

My first patient was coming in with some pelvic pain – it’s like the universe knows I love this stuff! I was going through the motions on the review of systems and turns out she’s had one symptom that she's been a little embarrassed about and hasn’t told any doctors about yet – that was an unexpectedly gratifying moment. We got her set up with an appropriate follow up appointment. Her pelvic pain wasn't caused by an infection she got from her partner, but she had been worried that he was cheating on her. I’m always surprised at what’s concerning patients the most and how often it varies from what’s on top of my mind. After writing up her note, Dallman and I took a quick jaunt to SFGH. I got to show her around a little bit. Our patient that I've seen twice now for prenatal care was the picture of a glowing new mom, pumping just right through the pain of cracked nipples (which at lunch I learned is some of the WORST PAIN EVER). Lunch ended up being a fun conservation about the pains and shames of being a new mom.

After lunch, I had a patient who was following up on a visit from 4 weeks ago. She was lovely but she talked SO much, like every question was an invitation for a tangent that spiraled too quickly for me to reel in. I feel like I’m pretty good at interjecting and redirecting but she just did not take any breaths and I couldn’t bring myself to stop her mid sentence. I felt myself zoning out. I even a little annoyed which isn't something I've felt a lot of towards my patients. I had gone in hoping to model this visit like a real family medicine one – and in some ways looking back, I guess I did. She was doing really well and had some interesting hobbies that I don't always associate with women of her age but again, people are always surprising me! Afterwards, I reviewed my notes with Dallman who gave me great feedback!!

Notes aren’t just documentation – they are communication with the next providers, WHAT do they need to know about your thought process? Keep it short and sweet, but don’t skip out on the main points!

It was nice to slip out at 4:15 instead of the usual 5:30ish. Today was the first day in a long long time that I got home before 5 PM. I then proceeded to fall down internet rabbit holes for an hour but I washed my hair (!!) and got some solid shelf studying in and did some medical humanities exploring and then ate dinner. Life is good.




Wednesday 2/27
I was feeling a lil down at the end of today and tried to think of one thing I did well today - but I had a hard time thinking about it and that almost made me tear up. It was a long day, I was there from 6ish in the morning to 8:30 at night. Things I did well now that I look back:

• Relative of one my patients who was diagnosed with something really sad teared up in the hallway, I told her that our kiddo has an amazing support system and that’s what sees people through treatment. I think that really meant something to her and it was validating to be able to comfort her
• Really pushing my senior and attending for feedback today and getting a lot of good stuff!
• Doing a physical exam on an infant just going through to motions only to find that there was definitely focal exam findings that I wasn’t expecting to see. Reminder that it’s so important to actually check for things instead of assuming they’re okay!!

Another thing on my mind is how hard having a child with developmental delay can be. I had this moment with one kiddo with a few neurological conditions who was so upset during my chat with mom, but when I moved in to try a few neuro exam maneuvers, he responded to me. He grabbed my fingers. He copied my finger making an H when I checked his eyes. He saw me tap my finger and thumb in rapid alternating movements and gave it a try too. He couldn’t talk to me, I wasn’t sure if he could listen to me either. But we had this moment of connection and I felt profoundly special for it. It’s a powerful feeling, and I understand a little better what keeps these families going, knowing that they’re the ones who can connect and make their kid feel heard, advocate for them and see beauty in a place that others may not.

When I got home, I talked to Smrithi and Sarah for a lil over an hour which was a nice way to wrap up the day.








Thursday 2/28
I got so tired on the drive home today. It wasn’t that long of a day, but I think it was a mix of things bringing me down.

• · Realizing how very far I have to grow in order to be a proficient student. I feel like I spent this whole two weeks trying to figure out how things work and wasn’t intentional enough about to push my clinical thinking. How do I think critically about every piece of information I present? And how do I show the team that I’m trying when we have limited time and space on rounds? I definitely felt better about my presentations today, I feel like I could defend what I was saying and was more confident going in. I had explanations for normal and slightly-off-normal findings, I had a better handle on our plan and the whys. But I have a long way to go. At least now I know what direction to grow in instead of chugging along thinking that I’m doing just fine. I’m so grateful for the specific feedback and that I really pushed people for it yesterday. It doesn’t really matter if this team sees my growth. It kind of bugs me that people only see me for being a cheerful medical student who can complete some tasks as they arise and not someone who is clinically competent BUT I’m just starting and I’m learning and everyone starts from somewhere.
• · I had a weird interaction with someone repeatedly during the day. IDK they had a strange energy and made me just second guess myself or defend myself; defending my thinking isn’t a bad thing and it’s helpful to be challenged that way. But I felt like whatever personal things are going on for that person this week, they just carried over into our interactions. I feel like it would have been easy for them to bring me under their wing but they didn’t have space for that I guess. After further consideration, I'm not going to let one person's energy bring mine down!
• · I was expecting to see a patient again, but I don’t think that’s going to happen. I was hoping we’d pick her to get a stuffed animal on for TK rounds but the afternoon was too busy for that. She’s been handed off to another team and it would be hard to drop in now without knowing enough about her care. I don’t even know what I would say to her if I saw her again. I don’t know how much I would help her and her family by being there, but part of me just wants to see them again. I’m definitely a little attached and sad.

One really sweet moment today was with a patient who was admitted last week, and we thought the family would be out in a few days but some complications came up with his treatment so they had to stick around for longer. This morning and the mornings before when I’ve visited them for pre-rounding, dad and him have been kind of tired and I felt like they were annoyed at still being here despite being very respectful and patient. I thought we were honestly just bothering them – today, we told them that we’re ready to switch to po medications and that he’ll go home tomorrow! We left the room, but then dad came out and was tearful. He said he gets emotional easy but that he was just so profoundly grateful for the care we’ve given his son and even though he’s ready to leave, he was really touched by the way we looked out for them during their stay. I wish I remembered the exact words but our senior told us to soak it in. Validation like that is so unexpected and so rare. It was a valuable reminder that we don’t always know how people feel about us, we can assume that they’re frustrated or annoyed with us, but it’s possible that they’re frustrated with the situation they’re in but not with me or the team specifically. It was such a sweet moment and I’m so glad he said something. A patient I followed last week who was discharged a few days ago left us a thank you note, she was grateful for our nurturing care. These moments are just the icing on the cake. I don’t need them and I never want to rely on them because they’re so rare and unexpected. But when they come by, I need to really savor them and hold onto them for future moments that don’t feel as validating.

I feel like I got to bond with another patient more today, I feel like I did a good job answering dad’s questions even though he seemed disappointed for getting the med student instead of one of the doctors at first. After dad left, we talked about AI controlling society and if there’s a way to truly be unbiased. I'm usually hopeful but a skeptic when it comes to technology saving us.

Other things I did well today: I had a productive morning despite being stressed at the start (I managed to pre round on everyone except the kiddo was gone for imaging, actually made time to just think about my cases, called the nurses about some questionable I&Os, prepped my teaching), my patient presentations went well even tho I didn’t get to do a full one on my new patient, I powered through lunch and took the lead on a patient who had evolving findings. I called pathology and I paged ENT and ophtho and renal, I figured out mychart; a girl was good about her tasks today. My energy level was pretty good.

Thinking about defining my successes more by the seeds I’m planting and less about the harvest I’m reaping. It’s so early in the season, time to focus on planting seeds! Other takeaways – don’t let OTHER people’s energy sap mine, don’t let other people’s unhappiness make me unhappy! I don’t have any reason to be unhappy! I have to be patient with my learning and growth, intentional with following through on goals I set. Not everyone is going to like me but my goal isn’t that, it’s to L E A R N.

Also ugh I caved and had a lil brownie bite and a lavender shortbread cookie NEITHER OF WHICH WERE THAT GREAT TBH and I think that’s why I got a headache and crashed when I got home bc of the sugar what!! Gotta be vigilant about what desserts I eat and making sure I stay fueled properly.








Friday 3/1

WHOA today was my last day of peds! I’m done with my first block! I can’t believe it’s been two months my goodness.

I drove to MB today, and when I was leaving my car, I saw a dad of one of my patients. Turns out his car battery died and he was looking for jumper cables, he had to go to work but AAA couldn’t come for an hour. I wish there was something I could do to help but there wasn’t. I hope his morning turned out okay. He spent all night with his sick kid. I wonder about our patients’ parents a lot – are they getting in trouble at work for taking so much time off? Where do they live? Who takes care of their other kids? Do they understand what we’re doing, do we make sense to them?

Another patient, whose parents are much more affluent, was getting discharged today. I followed them for a week, and they were truly so lovely and patient with us. Towards the end of rounds, mom was reflecting that she never would have wished for these circumstances, but being in the hospital and spending such quality time with her child just away from the hustle of daily life was an unexpected treasure that her and her husband really cherished. I thought it was such a wonderful sentiment, finding silver linings in the midst of the unexpected hurdle of hospitalization. She asked if she could take a picture of the team and her kid, it was such a sweet moment! But when we stepped out, our senior resident reminded us that these kinds of moments tend to happen a lot more with our affluent families. We also see families who don’t have the luxury of blocking out the rest of the world while their child is hospitalized. Our senior is lovely, she wanted us to soak in that moment but then remember the circumstances that allow some patient families to have those moments and keep others from experiencing hospital care in the same way.

Other highlights- one of our patients got a cellulitis but thought we were being mean to him about having cellulite LOL, but he was such a good sport about it.

I definitely felt some growth today. My presentations on rounds went well. Emma was kind and gave me feedback on the walk back. I got some boba and then reviewed some slides and went into for our shelf (which took longer than I expected but it went well I’d say!!) and then drove home woooo hoo!