it's the first day of my new rotation -- community of family medicine! i just accomplished my outside rotation. the last two weeks have been lighter compared to our 1 week in a public hospital somewhere in pasig, but the hospital i just rotated in came with its own challenges.
i was decked in ward 4 (onco/hema) ward where there are lots of leukemia patients (as mentioned in this post). then ward 8 where i stayed longer. ward 8 is the surgery ward where i was decked with a notorious resident who was rumored to throw a test tube at a junior intern but we were good when we worked together. we became close she bought ice cream for us and even asked for perfume recommendations. it wasn't so bad!
ward 8 was also full of interesting cases. i was able to handle neonates with omphalocele, gastroschisis, hirschsprung disease etc. it wasn't as depressing as the oncology ward, but it was humid (as the doctor's quarters weren't airconditioned). there is more room compared to the oncology ward so the relatives either sleep on the floor or beside the patient. i heard that some patients code (meaning, we have to resuscitate/revive them), especially neonates with multiple congenital anomalies, but there weren't any during my shift. some children came in just for the surgery (inguinal hernia, ruptured appendicitis) then was discharged after. some didn't stay long compared to the onco ward children who spends their life in hospitals.
i was excited during my pedia surgery ward rotation because i love surgery, i love scrubbing in surgical cases. i was waiting for an open heart surgery but i was on night duty when they had an operation scheduled :-( i was able to scrub in, however, in a bag insertion in a patient with gastroschisis. it was interesting.
my rotation ended with me being pulled from neonatal ICU to the hema/onco ward again. i was pulled out because a kid with myelodysplastic syndrome need to be monitored. she was on DNR (do not resuscitate). she was grunting, had high fever (Tmax 41C), and was seizing every now and then. when i got there at 8pm, everything was up (her temperature, heart rate, and respiratory rate). we advised tepid sponge bath to the mother after ordering an antipyretic, to which she complied, and had units of platelet concentrate standby. in the past few days, this kid was receiving platelet concentrates because her platelets were consistently, extremely low, to the point that she already had intracranial hemorrhage. this kid has polydactyly (with extra fingers) and trisomy 8. her mouth was red from the mucosal bleeding.
at 2 in the morning, she expired. the mother called me because her breathing seemed slow so i ran to the patient and immediately checked her heartbeat. my adrenaline was up, thinking of all the possibilities that could come after (basic life support sequence), but then i remembered that kid was on DNR, and that made me melancholic. i listened to the heartbeat and from 164 just an hour ago, it was 64. i checked the radial pulse and it was really thready, almost next to nothing. after a few more seconds, i listened to the heartbeat again and there was nothing i could hear. i informed the parents that their kid just expired and informed the hospitalist (junior consultant) on duty that the kid just died.
this time, i wasn't on the verge of tears like the last time a kid died on my shift. this time i was rational, i was thinking of what came after -- the papers that had to be prepared and submitted and the doctors i had to inform. i offered my condolences to the parents and left them to grieve. there is only so much i could do.
the hospitalist told me, "you don't have to monitor a kid hourly now," and i did not say anything. for me that kid was not an hourly monitoring hurdle for me. that kid's initials was A,D. that kid liked soup and stew. she was born with trisomy 8, myelodysplastic syndrome, and had polydactyly. her mother told me she was a good kid. and she just left this world, and a hole in her parents' heart.
