For the past week, I have shed my persona as a mild-mannered psychiatrist and have become--Pediatrics Girl! It's the start of a two month tour of duty on the pediatrics inpatient unit. As a part of our residency requirements, psych interns spend 4 months on some kind of inpatient medicine service. Since my interest is child psych, I requested and received 4 months of pediatrics.
Boy, was that a mistake.
Don't get me wrong--I really, really love kids. I love taking care of kids. I love being able to tell my patient, "There are farts in your belly and we have to take them out!" Or cracking my world-famous physical exam joke--"Now let's see, did you bring your HEART with you today?" and having it be funny. (60-year-old psych patients don't find that line NEARLY as funny as you'd expect them to.) I love being able to HOLD my patients in my arms, and having them be clean, and smell like baby lotion and baby powder, and seeing my medical students walking our kids around the unit in a stroller. I love how fast kids get better when they are with us. I love how everyone works together to really do a good job taking care of kids AND families. I love how we all get to know our chronic care patients, and how we all follow them even when they aren't ours anymore. I love the peds residents. I even love the nurses.
What don't I love? Well, I'm not a big fan of being pimped mercilessly on formal rounds. I KNOW I should know stuff. I KNOW I should be reading in my excessive spare time. (nooooot, I get there at 6 am and leave at 6 pm every day then COME HOME and GO TO SLEEP.) But do I particularly REMEMBER the pathognomonic signs of Kawasaki syndrome? No I do not. (Am I incredibly thankful for the med student who admitted that kid, who KNEW the answer?* Yes I am.)
I don't love calling DHS about a former preemie brought in with lethargy whose mom is throwing things at the nurses, cursing at the attending, and not allowing any medical exams. That's not very fun. Nor do I love having to talk to a family that lost one son in an ATV accident, and is now taking care of the second son as he recuperates from that accident. I don't love watching our heme/onc patients lose their hair and stare balefully at huge potassium supplement pills and refusing their PO antibiotics and sitting empty handed and empty hearted in their rooms. I hate that.
I still like pediatrics--I had a hard time choosing between peds and psych--but it's still not my place. I can't imagine myself as a general pediatrician. I can't imagine myself as anything but a child psychiatrist. I can't imagine not being with "my people." When you come down to it, it's just about a feeling of "rightness," of fit. I fit with the psychiatrists. Generally. The pediatricians are almost too earnest, too scrubbed and pure, too accurate and knowing. I like the uncertainty of psych, of trying things and being gray and being flexible. They can try all they want to recruit me. I'll still choose the smelly dirty guy wandering around downtown with all his belongings in a shopping cart, muttering about how George Bush has implanted electrodes into his brain. His people always come up with something new. There's only so many sepsis workups on 2-month olds that I can do!
*Fever, erythematous rash, conjunctival injection with sparing of the iris, palmar swelling, and lymphadenopathy. He did NOT have the classic strawberry tongue, but DID have cracked lips. His albumin was 3.5, which apparently is a good prognostic sign for decreased risk of vasculitis. At least I LEARNED...