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I’m definitely starting to get more comfortable in terms of flow. Still just working with the bronchiolitis patients, but I at least get to see the other patients while on rounds. There’s this one patient who just warms my heart so much. They came to the hospital in a pretty serious condition, to the point where they couldn’t really move any part of their body, but slowly is getting better. Each day I’ve seen this patient they have shown small improvements and most notably their smile. They can’t so much besides life their arm and make gross motor movements, and the occasional thumbs up, but there is cognition. They can respond appropriately when we talk (to the best of their ability), and whenever we come by the room, they always give us this big smile. Even though they’ve been in the hospital for days on end. Even though the parents aren’t able to be at beside around the clock. The patient seems content and happy to see us. Of course it’s hard to tell, but it doesn’t seem like a desperate, “so happy to see anyone” kinda happiness, but a genuine cheeriness that seems to be consistent with their character prior to having come to the hospital according to the parents. I’m glad they didn’t lose that.

Ok I’m actually really enjoying in-patient. It’s longer hours than outpatient, but it doesn’t really feel that way because there’s always something to do. There are occasional lulls, but those aren’t exclusive to in-patient. Getting to know the kids and families while they are in the hospital is fun and rewarding, and everyone I’ve worked with so far is just so pleasant to be around.

I got my second patient today, and then later took on a new admit. What did they have? You guessed it, bronchiolitis. I should be an expert on this by the end of the rotation, we’ll see. Hopefully one of these days I’ll get to work on something different, but I do appreciate getting eased in to things because even with something as relatively simply as bronchiolitis there’s a lot of think about in terms of counseling parents, planning, and communicating with other members of the medical team. Even the thought of doing that stuff for a mildly more complicated cases is kinda intimidating.

I also like the idea of in the future working in a teaching hospital and working with residents and students. We have like 3 conferences everyday, some of them are kinda fun and we learn cool stuff and hear about interesting cases. As an attending I see how working in a place like this really helps keep you up-to-date on the latest research and guidelines and just gives you an opportunity to see a wide variety of pathology. Am I in love? Who’s to say? Let’s get past the honeymoon period and I’ll get back to you.

First day of in-patient pediatrics. So begins what I’ve been told is 12-hour workdays. Had to be out of the house by 5:30 AM. I gotta started shifting my sleep schedule. Getting up wasn’t so bad though, probably in-part because I was actually kind of excited. This is where I’ll get to see a lot of the more acute pathologies and the “zebras” (a somewhat appropriate term given that I need to take the “giraffe” elevators to get to my unit) that you usually only see in board questions. After meeting the residents, both of whom seem really awesome and chill, I get my first patient. Boom, bronchiolitis. Ok that one’s not so rare (there were a few cases, and there will probably be more in the future), but I’ve never actively seen a patient with it. Things only got more interesting as we went on rounds. I heard some stridor in-real time for the first time.

It was a busy day, and I felt like I was constantly jumping from one thing to the next. Pre-rounding and sign-out, teaching session, rounding, charting, lunch conference, more charting. Luckily, I only had the one patient and my residents let me out early today. I kinda wanted to stay, but also recognize that I probably should take free time when I can get it. They assured me that there would really be nothing interesting to do the rest of the day and that tomorrow they will have more patients for me. I guess we’ll see how I feel then.

It’s easy to get the two mixed up.

Probably the first time I was formally introduced to the idea of empathy was in my 9th grade English class when we were reading Harper Lee’s To Kill a Mockingbird. The famous line from Atticus Finch goes:

You never really understand a person until you consider things from his point of view… until you climb into his skin and walk around in it.

I remember at the time so much emphasis was put on this line, as if it was this revolutionary new way of trying to understand people. I certainly thought it was. And based on the context of the book and the history, it very possibly was. Looking back though, I think in many ways it sets us up for developing a misguided form of empathy that is more similar projection.

When we “put ourselves in another person shoes” we tend to take everything with us, our perspective, our worldview, our experiences. We project ourselves into another person’s situation. We simply think, If I were in their shoes, I would do “x,” and then we get surprised when they decide to go down a different path (insert surprised Pikachu face here). True empathy on the other hand requires us to forget ourselves for a bit. We need to abandon our own way of thinking and try to see the world through a set of completely different lived experiences.

I’m confident that intention of phrases like these is to elicit true empathy, and maybe for most people it does and I’m just a sociopath. I just think we need to be careful about using catchy phrases to explain or describe emotional processes and reflective practices because, for example, engaging in projection instead of empathy creates an illusion of understanding, while at the same time giving the person a false sense of moral security that they have done their due diligence to “see the world through another person’s eyes.”

Why are humans the only members of the animal kingdom that use toilet paper (beside the obvious fact that invented it and have the “intellectual” ability and dexterity to use it)? This may also be an ethnocentric question, but regardless of what you use to clean your ass, the question remains: why do we need some extra “tool,” be it TP or a bidet or a hose or a tabo, to maintain personal hygiene down there. Could you imagine if we didn’t? What kind of world would that be? Utter disaster. But look at dogs; dogs don’t use TP and 80+ percent of the time after they take a shit their butthole is pristine. Their ex-bowel contents neatly taper off into a chocolate carrot and then they’re on their way.

For humans? Whether you’re a clumper or folder, you are lucky if you can get away with using less than 4 slices. No denying there is the occasional squeaky-clean deposit, where 0 TP is needed, but you still need to use at least 1 piece to check (unless you are just an absolute monster).

Part of me thinks it’s diet. If we ate more fruits and veggies, our poops would probably be cleaner. Dogs and cats eat barely any leafy greens and they don’t seem to have an issue. So then maybe is physiology? But why on earth would they have a more advanced digestive tract then us? They probably don’t, it’s just their GI system is more in-tune with their diet compared to humans. The diet of average western human is very different from what we were built to be consuming, so maybe that’s why? And so early humans seldom had the problem and so had no need for toilet paper.

Part of me also thinks it has to do with our anatomy. Our butts are way bigger than pretty much all other animals, relative to our size that is (the main reason being because our glutes need to be big to keep us upright all the time). Maybe that makes it more difficult. Or alternatively, maybe our voluptuous cheeks helped conceal some of the stank between proper cleanings prior to the invention of TP and the Toto BT784B.

Whatever the reason may be, the point is humans are just strange creatures.

I recognize that this whole post is imbued with my own privilege and western bias, and that there are populations in our cities and around the world that do not have access and/or are being actively limited access to hygiene resources. This is all written as a random stupid thought I had which hopefully was apparent, but I think it’s still important just to be mindful of the broader picture of the world we live in.

This was written in post-because I missed writing the day of.

Last day of outpatient. And last day in the cardiology clinic, definitely my favorite of the specialty clinics. The attendings were the most enthusiastic about teaching (matched only by some of the continuity clinic attendings) and watching echos is just so cool. Pediatric cardiology has definitely been on radar as something I may want to go into, and my experience the last few days has only reinforced that. But we shall see, I still like the idea of doing more primary care. I like the idea of making short terms plans and goals with patient and following up on them in a longitudinal manner. BUT being able to use an ultrasound machine on a daily basis sounds pretty cool too. And the schedule also seems pretty nice.

Next week we start in-patient which I’m really curious about. I’m not sure how I’ll find it because on the one hand I’ll get a chance to spend a lot of time with individual patients. Days are going to be long, but hopefully I’ll be doing interesting stuff the whole time. This is going to be the first time where I’ll really get to see if hospital work is for me.

This was written in post because I missed writing the day of.

During outpatient, we have to spend a day working in the Newborn Nursery and NICU. I was looking forward to this experience because it was something we never really saw much of during OB/GYN, and also having volunteered in the NICU before I was excited to what the LAC-USC NICU was like.

Overall, it was a lot slower than I imagined. We only saw and examined one newborn in the morning, which itself was a good learning experience, but was just — lonely if that makes sense. We then did a quick morning “rounds” with the attending where we went into all the potential causes of poor feeding and failure to thrive, which was also a good learning experience on its own.

That said it seems like the residents and staff didn’t really know what to do with us. In the afternoon we were supposed to be in NICU with one of the clerkship directors, so I was hoping we’d get a little more direction, but it turns out she wasn’t coming in today. One of the attendings did send us over to this empty NICU unit to watch a training on neonatal resuscitation. That was interesting and we got to practice some stuff like CPR and intubation on neonates. The residents decided to let us out early which was nice.

Afterwards I busted a mission back home for a concert which I forgot I had tickets for until this past weekend when Audrey reminded me. I was a good time.

Every time I talk about being in my pediatrics rotation, the conversation always somehow shifts to how sad it must be. And of course, over the course of this rotation I’ve encountered a lot of sad situations. The thing is though, at least for me, when you actually meet these kids, often the last thing you think about is how sad it all is that they’re sick.

In my very, very limited experience, think one of the worst mistakes you can make when working in pediatrics is assuming the patient is sad because they are in the clinic, or in the hospital, or because of the situation. Actually, that maybe applies to all medicine, but maybe especially with kids. A lot of the kids I’ve worked with are happy, normal kids. Nurse, doctors, hospitals, medicine, for some of them that’s the only life they’ve known, and sure you may think that’s sad because you think they are missing out on some part of life that you got to experience, but just because that’s how you see their life, doesn’t mean that’s how they see their life.

I’m not denying that any illness, regardless of severity, can be associated with sadness, depression, anxiety, stress. When bad things happen to kids, it’s especially sad, but that’s why it feels all the more special when you get a chance to be a part of their joy, to maybe let them feel “normal,” or to help them get better.

This one was written in post, since I missed writing the day of.

Was just another morning in the allergy clinic. It’s really interesting seeing the differences between doctors of different specialties in terms of personality and behaviors. I think it’s definitely something to take into account when deciding for myself. The attendings I worked with here are really great, though I don’t know if I really enjoyed the kinds of cases, we were seeing in this clinic.

It was a short day today in the allergy clinic. I had the afternoon off as study time. The allergy clinic isn’t exclusively for kids though, so I did see one adult. It was all asthma and possible allergic reactions. One of the doctors I worked with was really exceptional. She was very good at talking with patient and just had this very calm, wise, air about her. There was also another case of twins which is always interesting.

Working with kids in the clinics and in the hospitals makes the news from yesterday hit just a bit closer to home.