As I continue through the pediatrics rotation, I’ve been thrust into the emergency department so that I can enjoy the faster paced side of this field. One of the problems with my school is that medical students are only assigned low acuity cases. I can see paramedics roll a 10-year-old down the hall who is seizing and get to watch in awe as the residents proceed to take over and run the case. While I’m enjoying the show, an attending will invariably tell me, “Okay, it’s time for you to go check on that kid with a running nose.”
While I love emergency medicine and think that I might want to pursue it as a career, pediatric EM certainly makes me want to go running and screaming in the other direction. I had a mother come in this week with all three of her children registered as patients. Patient #1′s complaint: cough. Patient #2′s complaint: sneeze. Patient #3′s complaint: watery eyes. I asked the mother why all three of the children had to be brought to the emergency department. She replied, “They had today off of school, so I figured I would bring them all in to get checked out.”
There are two routes to becoming board-certified in pediatric emergency medicine. The first method is to go through residency in emergency medicine, and then pursue subspecialty training and pediatric EM. The second method is to do pediatrics first, and then pursue an emergency medicine fellowship. I can always tell who took the EM route based solely on their sense of humor. If one of our cold and flu patients is seeking a prescription or a workup, the reply of the attending physician quickly tells me what kind of training he went through. If he replies, “Let’s do a full sepsis workup including blood cultures, urine cultures, blood count, and then watch the child to see if we need to do a lumbar puncture or a chest x-ray,” then I know he took the pediatrics route because of his willingness to over order to test while wringing his hands over a possible diagnosis. If on the other hand, the attending wants out of the patient’s room and calls out, “I don’t want to see anyone writing a prescription for this person,” then I know that he doesn’t play around with unnecessary tests and procedures—he went the emergency medicine route.
Since we serve as an urban trauma center, we get to see the worst case scenarios. Because of that claim to fame, I’ve also seen quite a few child abuse cases. A 3-month-old came in suffering a seizure. We ran her through the CT scanner and found that she was bleeding into her brain. We then did an eye exam and saw that she had multiple spots of bleeding in her retina. Apparently, the father had thought that she was crying too much and decided that the best way to calm her down was my shaking her vigorously. He was arrested, and the mother—and who was completely oblivious to the father’s treatment—took over as the sole custodian.
Our peds department comes up with many ideas to improve patient satisfaction, particularly while the family waits. In the emergency department all of our patient rooms are private with a television set in each room. When I walk in the TV’s volume is usually on the highest setting. Whenever I try to ask questions everyone in the family merely gives a “uh-huh” without looking away from Dora the Explorer. I once watched a physician get so frustrated with the nine-year-old’s ability to pay attention that he said, “I’ve seen this episode; Diego makes it,” and then turned off the TV.