work

To give you a few brief details about work:  I am on Child Health-1, which is ID and endocrine, although we see a bunch of other stuff.  We have outpatient clinic (called OPD) on Mondays and Thursdays, which typically lasts from 8 a.m.-6 or 7 p.m.  We have inpatient rounds (called wards) on Tuesdays, Wednesdays, and Fridays, and the residents do brief rounds after I leave on Mondays and Thursdays.  They work hard, seeing patients before rounds and after clinic, sometimes staying till 11 p.m.!

I don't do anything by myself but basically function as an observer for both inpatient and outpatient.  This is a little frustrating, especially for simple things like typing up discharge summaries copied from the chart or writing prescriptions, but with the language barrier for patient contact and the myriad of diseases I've never seen in the States, it's also a bit relieving.  I am reminded of how little I know of how things are done in the States for peds, either, though, since I did a week and a half of inpatient in third year and four weeks of outpatient, most of which was well child checkups.  There is well baby clinic here for shots and checkups, but the outpatient clinic is all sick visits.

I've seen some pretty crazy stuff.  Cervical lymphadenopathy has turned out to be either Mycobacterium infection (either M. TB or MAI) as well as Hodgkin lymphoma complete with Reed-Sternberg cells on outside biopsy.  A baby with apneic spells today got intubated and sent to the ICU and turned out to have an intracranial bleed, so I felt my first bulging anterior fontanelle.  I saw a four-year-old who has received nearly forty (or was it sixty?) blood transfusions for beta thalassemia major and had a spleen that caused abdominal distention and was palpable to within centimeters of his pelvis.  Many patients have hepatomegaly, and I've felt several spleens that are smaller than that one.  I saw a patient with probable Prader-Willi syndrome (feeding difficulty in infancy and failure to thrive followed by uncontrolled weight gain with mental retardation and developmental delay - one of the very few obese patients I've seen), Noonan syndrome (the male version of Turner syndrome), and probable spinal muscular atrophy (SMA - floppy baby with absent reflexes).  So some crazy diagnoses and physical findings.

I have to head off to the international student weekly dinner out, but I am enjoying my time, feeling like I am more a part of the team (despite not doing anything), and learning a good bit about all sorts of interesting medical illnesses as well as some Tamil along the way.  So far the latter includes numbers 1-10, "how are you?", "how old are you?", "what's your name?", question words, the word for pain, and some body parts.  ;)