nANIMOv

There are a lot of things about inpatient medicine that I like. We always talk about continuity and longitudinal care as being major aspects of primary care, but during a hospitalization you get a lot of face time with patients. You see them every day for as long as they are in the hospital, and for a lot of these kids it’s been a pretty decent amount of time. The attendings and fellows have pretty strong relationships with some of them. Of course it would be better if they could get well and go home, but it is good to see that there are people who care a lot and have a lot of love in their hearts working to get them out of the hospital.

It was true, the heart function (formerly heart failure)/ transplant service was quite a bit more intense. The first patient we rounded on today still had an open chest from his most recent surgery and a few of them were having their blood pumped via a machine pumping their blood externally from their body (Berlin-Heart) and one was on dialysis. All of this is understandable they most of them were listed for possible or future heart transplant, but it doesn’t make it anymore heartbreaking.

What was encouraging to me though was the spirit of a lot of these kids, some of whom couldn’t even talk (some for development/ age reasons, some because they were on a ventilator). They were so cute and happy and interactive. It’s easy to forget that these are normal kids because as an outsider they are going through so much. It’s easy to pity them and treat them as “sick kids,” instead of just as a regular kids, and while they do need specialized care, they also need all the things another kid at their age needs. They should get to feel normal, even if just for a little bit each day.

We also had a really good discussion during journal club this morning about women and underrepresented minorities in medicine which sparked a pretty lengthy and provocative discussion involving the fellows and faculty (even I was called upon for comment being mistaken for a resident).

If the age of the oldest attendings is an indicator of the long-term physical and emotional sustainability of a specialty, pediatric cardiology would probably win among the rotations I’ve gone through. Jokes aside, as I mentioned before most of the cardiologist seem pretty balanced and happy. That said it does seem like it can get pretty intense and plus there’s call.

Overall, today was pretty good. I got to present my first patient and I thought I did a pretty good job for it being my first new consult presentation on the cardiology service. As stressful as it was, it was kinda nice to be back to actually feel like I was doing something/ able to show what I can do. Tomorrow I switch over the the heart failure service, which I anticipate will be a tiny bit more taxing that the acute service I was on these past couple days, but we’ll see.

It was my first day on inpatient pediatric cardiology. Definitely different vibes to outpatient, but pretty much what was to be expected based on my previous experience in inpatient medicine. I will say being on a specialty service is definitely different though compared to being on the primary team (despite the patient’s being admitted to a cardiac-specific floor). While I’m still missing some of the other interesting pathology that exists out there, there is plenty of really interesting stuff and some really deep cardiology that is constantly keeping me on my toes.

I will say, of the attending physicians I’ve met, none seem to genuinely enjoy what they do as much as some of the pediatric cardiologists I’ve worked with. Having had a chance to pretty much work with a new one every day, they also seem pretty happy and also it has been interesting seeing all the different practice styles. Some of them definitely do things that I could see myself doing in patient encounters. Others do things that work for them but personally would emulate (not necessarily because I think it’s bad, it’s just not me). One of the attendings did mention that is could be possible to still do some primary care/ general pediatrics as a specialists if you really pushed it, so that may be something I look more into further down the line.

There been a decent need for Spanish ability here, perhaps more than I expected, which has been good (maybe 30% depending on the day, compared to the 40-50% when I was on Med-Peds). My goal continues to be becoming more fluent.

Today I was assigned to the cardiac stress testing lab. You know those scenes of athletes hooked up to a bunch of wires and tubes riding a stationary bike or running on a treadmill while people in lab coats with clipboards watch from the side? Yea that was me today. One of the clipboard people. It was actually pretty cool. The patients who came in either had a known preexisting hard condition and we wanted to make sure their heart could keep up with some exercise or there was some kind of concern for an exercise-induced heart problem. Unfortunately we didn’t see anything super abnormal, but also fortunately for the kids’ sakes. Seeing all that exercise made me thinking how I really need to get back into doing more exercise, it is just pretty hard to find the time these days because of my commute. I know it sounds like an excuse, but if I could find time to go climbing during the week without compromising my other responsibilities I definitely would.

It was a pretty good day in pediatric cardiology. A couple surprisingly interesting cases. Surprising because they were supposed to be basic consults with normal workups and no cardiac relevance, but ended up being potentially cardiac-relevant. There was a good amount of talk about wearables today as well. One patient caught some interesting heart stuff (possible SVT) on his Garmin heart monitor belt/ strap thing. One patient’s dad developed an Apple Watch app that tracks and plots his daughters heart rates on a graph. All the patients and families were so lovely and now that I think about it I haven’t really encountered a “difficult” family during this whole rotation so far. While there are some stuff I’m still missing here in cardiology, there are also certain things I here that I like a lot that I definitely wouldn’t get in primary care.

It’s crazy meeting some of these kids after learning about their heart conditions and how differently their hearts developed and the procedures that were performed in order to give them a physiologically functional heart. And then to see them living, breathing, talking, laughing, walking in front of me is truly truly wild. We had some real characters today, and even for the ones who make a lot of trouble, it can be hard to get impatient with them because their troublemaking means they’re healthy, and that just makes me happy.

I’m definitely getting used to the process and routine of clinical cardiology. Check the chief complaint/ reason for visit (not different from primary care), review the echo and the ECG that they likely came in today for, review any other relevant details, go see the patient, get the history, tell them the plan. For a lot of these clinic patients, they are relatively stable which makes sense since we are seeing them in a outpatient setting, but that usually means we don’t have much for them by way of follow-up if everything looks good. The shortest follow-up is usually with the new patients (if there is any follow-up at all [there are a lot of referrals that end up not being cardiac related]) for a couple weeks just to go over the results of a simple work-up. A lot of the RTC (return-to-clinic) dates are set for a year or more. Still figuring out how I feel about this.

It’s been weird going from my last rotation to this one. In Med-Peds I was decently independent, able to see patients on my own, propose a plan, write notes, etc. Now I’m pretty much shadowing. It’s not like the encounters in cardiology are anything beyond my ability, they are actually pretty straightforward in terms of plans and history, I think it’s just difficult for the attendings to maybe trust a student when they are not used to having one. I think a big part of this rotation for me is taking initiative and asking for more responsibility if I want it and to essentially show what I can do, but also without being a burden to the attendings or anyone I’m working with (i.e. slowing them down).