You don’t know how frustrating and condescending it is when you’re doing your best to speak your patient’s native language as best you can (and not doing half bad given that you haven’t really practiced in a couple months), and your patient’s mother and grandmother start laughing and making fun of the way you pronounced a word. Yes, I had my stethoscope on, ladies, but it ain’t exactly soundproof. And I can understand much better than I can conjugate.

I’m as obviously gringo as they come, but it’s obvious that I’m trying my best, and I’m making an effort. I don’t care if I’m a medical student or your doctor or the guy who cleans your toilet; it’s rude, flat out.

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I’m all for doctors and medicine trying to be as objective as possible, but it’s just so damn cute when doctors think they actually are objective. As if we don’t bring our own values and assumptions to the table. I’m doing well-child checkups this week at a county health clinic. I walk in, see a 9 month old baby, a 40-something year-old woman, and a 16 year-old girl, and immediately turn to introduce myself to the 40-something year-old woman, because clearly she’s the mother of this child; 16 year-olds don’t have babies!

I cringe every time I recall this story.

Next is the number of superstitions we go through as physicians (luck and superstition are clearly objective, too). For example, I will never, ever mention how a day or night of call is going smoothly, or how quiet the pager has been, or how empty the floor is. I will think it, and consider bringing it up for casual conversation, but it stops there; for if I mention anything to that effect, I will jinx the team and we’ll magically have 20 new admissions that night. I know this is totally crazy, but I totally, 100% abide by this. I don’t know that I totally believe it, but I’d much rather keep my mouth shut and hopefully have fewer admissions.

And it’s only medical things that I’m superstitious of, which makes it even more ridiculous–in the medical world, where we base everything on risk, benefit, and predictions from data and randomized, double-blind controlled trials, I truly act in a certain way, hoping my behavior will somehow influence the outcome.

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The first expression of religion I’ve seen from an attending happened more than 9 months into my first clinical year:

A very, very sick pre-teen that we made sicker with chemotherapy wasn’t initially improving when he should have been, and the oncologist told us that she hasn’t slept in days, worrying about the child’s health. After another sleepless night, she told us that she

“Sat down and just prayed. Just prayed that [the child] would be okay, and that his counts would come back. I figured it couldn’t hurt. And then my daughter came into the room, and asked me what I was doing. And I said, ‘I’m praying for a little sick child who needs to get better,’ and my daughter decided to pray with me. And then my other daughter walked in, not saying a word, and sat down, bowing her head as well. After about a minute, she whispered, ‘What are we doing?'”

The attending on staff said that he knows an Indian adult oncologist who can get 1,500 people praying for a patient back in her hometown at a phonecall’s notice.

Desperate times call for desperate measures, I guess. Kate and Matthew discuss a Forbes article noting that doctors are more religious than the general public, at least according to the survey. I think it’s easy in medicine to lose faith in God or religion day-to-day; you see terrible tragedies walk into your office or hospital on a regular basis. But I think there’s probably a part of many physicians that at least hopes there’s something more to all of this, something out of our control. It’s not something that we can rely on–but at least something that we can try to call upon when our medicines simply aren’t enough, or when we could really use the scale to tip in the right direction.

One of the many reasons medicine’s an art, not a science.

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Busy learning Peds, which I’m really enjoying. A quick eval, starting with the pros:

• The people–doctors, nurses–are just nice . You don’t realize how not nice some people are on other services until you do Peds.
• Your patients are for the most part, cute.
• Kids are resilient, and can make it through some really serious disease that would probably kill an older person.
• Most have reeaaally short Histories of Present Illness (2 days of decreased bottle intake and 1 day of cough), reeaaaally short Past Medical Histories (full-term baby) and usually are taking no meds.
• Peds is pretty straightforward. Kid is dehydrated and can’t keep food down? Give IV until kid can keep hydrated on liquids, then discharge.
• For the parentless hypochondriacs like myself, if you don’t already have any of the terrible pediatric diseases, you won’t have them.
• There are many pediatric specific diseases, but most of Peds is medical management.
• Kids have nice clean arteries and veins and organs, and for the most part haven’t screwed them up with alcohol and drugs and cigarettes. (I screw mine up, too, just like any other adult.)
• You throw antibiotics at everything.

The cons:

• Kids are germ factories, and you will get sick while you’re on service. I can’t count how many times a patient has coughed right in my face.
• If they’re young, they can’t tell you what’s wrong with them, or what hurts.
• One word: parents. I’m astounded at how different parents can react to certain degrees of medical illness. Some parents are great, others need to chill out and/or stop coddling their children. (Yes, I know people have different styles, yes, I know you have to work with the parent where they’re at.) It just seems like too many parents want their kids to be their friend , when the kid needs a parent , not another friend.
• For the parent hypochondriacs, your kid could have or get any of the terrible pediatric diseases.
• It’s hard to get IVs.
• You see a whole lot of kids with congenital or lifelong diseases that have no treatment.
• It sucks making babies cry.
• It sucks having to calculate drug doses and fluids by kilogram.
• There’s a lot of turnover, so you honestly can’t remember a kid you discharged 2 days ago.
• You throw antibiotics at everything.

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Oh hellll yes. Did my first lumbar puncture (aka spinal tap) today. On a 5 year old. Champagne tap! (A “champagne tap” is when you get clear CSF fluid without any red cells in the fluid, as they can often contaminate your results.)

My attending, being the awesome guy he is, ran out and bought me a mini bottle of Korbel to celebrate.

I love procedures.

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It is really, really refreshing when your patients have no other medical problems, are taking maximum one other medication, have a short history of present illness, and are really cute and wide-eyed.

And don’t talk back.

Thank you, Pediatrics.

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