some days after being in the hospital, i just have so much to process (and typed phone memos are probably gonna disappear before they get posted). takeaway from todayās day in clinical: i cannot work in pediatrics. starting last week, instructors and other staff around Childrenās Hospital kept saying āeither youāre a peds person or youāre not.ā not in a mean way, but i guess to give us a feel of what itās like to work in this environment. as a prospective future Family Nurse Practitioner, children could be inlcuded in my clientele, as iād be licensed to see/treat them, but it wouldnāt be imperative. i personally donāt feel that working with kids is a necessity for my sould, but iād be okay with it, so i didnāt get why itās so polarizing. but today. oh, that changed today. read on with caution, though i doubt my re-telling is as emotionally scarring. the cutest patient of the day was an 8-month old baby girl, born prematurely at 34 weeks. she was a wee little thing and so happy. but at barely 10lbs and super low tone (think floppy baby), all i could think was that she wasnāt meeting her milestone of sitting up on her own at this age, and even considering her being a preemie, sheās still lagging 3-4 months behind with not being able to hold her own head up. so in addition to the actual reason she was admitted to our neuro floor, we know this could be an indicator of cerebral palsy. next youngest was a 20-month old boy. saddest story here. happy, healthy boy until he was 12 months old. non-accidental trauma committed by his babysitter. she had intentially harmed him in some way that caused permanent brain damage. this means developmental delays and likely a lifetime of dependency on his parents. heās not even 2. we had a 8ish year old boy, obviously delayed, nonverbal, and with some physical impairments. mother requested a fully-enclosed tent-type bed arrangement for him because, as it became very apparent, he wants to climb and pry his way out of any crib/bed. when we were asked to take his vitals (sneaky nurse thought itād be a āfun workoutā), there was clawing, wriggling, jumping, biting, kicking, pulling, and i even caught myself in a near chokehold for a moment. the mother offered to hold him in her lap for us and tried distracting him, feeding him, and even held his chin tight as he attempted to bite the BP cuff, etc. i looked up and the look in her eyeā i swear she was praying to God, desperate for her child to calm down for a moment for us to get vitals. a tween girl with a history of migraine headaches over the past year was admitted for evaluation, recently experiencing some numbness/tingling and double vision. her MRI showed multiple sclerosis. that basically means a lifetime of worsening/impaired neuromuscular function and early death from a disease that we donāt even know how to prevent or cure. the adrenaline-inducing bits of the day came from a 17 year old boy who recently had huge changes to his medication regimen (even questioned by the NPs on staff). completely switching up his mood stabilizers outpatient led to acute episodes of mania and required four-point restraints inpatient after making a couple attempted escapes. at one point after he had been calm, the restraints were removed and he immediately made a run for itāas he disappeared into the NICU, bottomless, his mother stood in the hallway, distraught and in tears. and finally, āmyā patient of the day, another 17 year old boy. admitted for expressing intent of self-harm, suicide, and delusions per mother. psychiatry agreed that with his health history, a mental health facility placement would not be best for him. but the only potential alternative to sending him home if he became more mentally stable would be to send him several states away to a facility that would accept him and be able to manage his other chronic conditions. these cases are how i realized this patient population is not for me. maybe itās not the reason why most people decide they āhateā peds rather than love it, but i had such a heavy heart on my drive home. some people love peds for the bright walls, big smiles, child life services (which i just learned about and they are AMAZING at helping children cope with anything medical-related), creative ways to liven up the environment, resilience of the children themselves, and morale of the staff. and maybe itās just the age and life stage that iām in, but i canāt see these children without thinking of the āworstā that can happen to the children i hope to have someday. say you are able to get pregnant--premature birth is a risk factor for so many things. say you have a healthy, full term baby--a trusted caregiver can cause such destruction at a momentās notice. say you find the strength to be so much more for your child than you ever anticipated--it will get tiring and there will be times when you simply arenāt enough. and if all goes well... maybe itās only for the time being. so yeah, all in all, i know this is just one rotation, and i do enjoy being able to care for and help all of these children. but i donāt think i could stop myself from ābringing work homeā or keeping a mental separation between those children and my own. i now better understand people who could never imagine working in a hospital or healthcare in general and those who never want to hear hospital stories, even if it is my current life. i encountered similarly devastating patient cases and diagnoses in the adult (ED) world, but this just hits different. and i guess it was supposed to.
