Posted by: Jas | December 8, 2012

Change of heart.

4 weeks into my much-anticipated Paediatrics rotation and I ask myself what drew me to it in the first place.

I don’t know if it’s because of the way this particular unit runs. Different consultants are on call each day, who are responsible for the day’s intake, which means multiple consultant ward rounds a day that can occur as and when the consultant rocks up. The registrar roster is all over the place, with the same reg on for a maximum of 2-3 days at a time. Don’t get me wrong, the consultants & regs have all been very patient and helpful. But because of the lack of continuity, there’s just no real feeling of a ‘team’.

Or maybe it’s because I didn’t like paeds for the ‘general’ stuff. Or perhaps working as a resident is completely different from being a student.

The Special Care Nursery job got boring after a while. Most of the time, it is either potential sepsis admitted for IV ABx, or jaundice admitted for phototherapy, or NAS admitted for morphine, or premature/low birth weight babies admitted for feeding establishment. Every day it’s ‘how is baby feeding?’, ‘is baby gaining weight?’. Yawns. Also, probably because of the demographics of the population surrounding the hospital, we deal with a fair bit of social issues, eg drug use, homelessness, domestic violence. In some cases, these mums need to be hassled to come to the nursery to visit and bond with their babies. Yet there are people out there who want babies but cannot conceive. Ironic, isn’t it. The nurses there can be quite pushy, sometimes insisting on doing things their way, overriding the decisions of the regs or consultants. Yes I respect the fact that you have plenty more experience than I do, but you don’t need to come across as condescending, and you don’t have to put me down in front of my seniors.

The Children’s Ward job isn’t that much more exciting either. Recently it has mostly been asthma, bronchiolitis and gastroenteritis. Most of them get admitted for overnight observation and by the time I see them the next morning I’m doing their discharge paperwork. We’ve got a couple of kids with FTT at the moment, which honestly doesn’t interest me. I think all these growth and development stuff is not my cup of tea. One of them is a 5 month old child who has put on < 2kg since birth (normal is about 1kg gain a month). He’s got good growth in length and head circumference, and all investigations so far have come back normal. We’ve decided that it’s likely due to insufficient caloric intake rather than any organic cause. Mum is adamant about not giving formula because ‘it is not natural’. Like seriously woman, would you rather your child starve?!

Attending elective Caesars is part of our job as well, and sometimes if the reg informs me I’ll go with them to the emergency ones, just to get experience. Went to 10 in total last week, which is more than what I assisted in when I did O&G! (Un)fortunately, all the babies have come out well and healthy, and I haven’t had to do anything more than give one baby some free-flow oxygen.

What drives me insane are the referrals from the postnatal ward. Gosh. I thought I was done with a certain group of people when I finished O&G, but I am still haunted by them every day. I was told that they have to refer anything that is not normal because it is outside their scope of practice. Surely some education on what’s acceptable as normal variants (eg pale red eye reflexes, small fontanelles) can help reduce the number of referrals we get a day? On top of the 3-4 that we have on our list to review daily (eg low birth weight, premature babies, potential sepsis awaiting blood test results, babies on BSL monitoring), we usually get an additional 3-4. Sometimes I feel that we’re practically seeing all the babies on the ward! Seriously, they might as well set aside an hour every day where the babies are lined up for us to review.

We always get hassled to see these ‘abnormalities’ found on discharge checks asap because they are waiting to go home, but please understand there is only one of me (and one registrar), and we have our own patients to see and our own discharges to do as well. Most of the time these aren’t even abnormal anyway. That’s where prioritising comes in, and there is no point telling me ‘not till tomorrow’ when I say ‘this can wait’. It will wait until I have done everything that has a higher priority, and then I will decide whether I can see the baby today or it will have to wait till tomorrow. I’ve also gotten useless pages such as ‘please review new referral on postnatal ward’ with no name/patient details/phone number, and I would have absolutely no idea whether it’s urgent or not.

I don’t know if I’m feeling this way because I’ve had a bad week, but I haven’t really enjoyed myself so far. 8 more weeks to go, I hope things improve. The good news? Now that I’ve tried paeds, I’m fairly certain ED is the right choice for me.

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