More favorite toys

Chalk this up to a weird pediatric sense of humor, but I love these little critters!  A drug rep. brought the E.coli version into the office to promote her UTI drug.

Have seen a few of these in the past 14 days H1N1 virus particle greatly magnified.

community acquired meth resistant S. aureus (MRSA)Super Bug! 

Penicillin mold.Have used a little of this to treat Strep throat.

Wash your hands!

so you don’t get

This… the common cold (Rhinovirus)

Or this…. Seasonal flu virus – Orthomyxovirus

Loving Pediatric Medicine – the anti-rant

Reason Number 30:  Spouse Support

The saying goes that it takes a village to raise a child.  A physician also needs the support of a village to do the job of medicine.  Running a pediatric practice is an on-the-job MBA.  Medical school and residency taught me many things, but accounting, marketing,  public relations, employment law, OSHA and CLIA regulations were not part of my curriculum. 

My husband in the yin to my yan, the peas to my carrots, the sunrise to my sunset, and the bass to my soprano.  His education was about all those things I’ve learned through experience.  In his former life, he ran a “village”.  Our strengths compliment each other in the business. So it was natural to ask him to run the operations/management/administrative side of my practice. 

Working together is not a cakewalk.  The division of responsibilities is dynamic.  I’ve stepped on his toes and he’s stepped on mine, and despite our best intentions work comes home with us from time to time.  Our tendency is to take shifts both at home and when the office needs our attention outside of our usual 9-5.  That flexibility enables him to do pick-ups at school, errands for home and office simultaneously, and meet the washing machine repairman.  Sometimes he’ll work after the kids go to bed when all is calm and quiet. 

My spouse is the extrovert of the two of us which is ironic since he spends most of his day at his desk filing insurance claims, keeping me and my partners on track with CME, credentials, and scheduling, and juggling all tasks that happen behind the scenes.  It’s a treat to hear him talking to patients and parents when he’s able.  He’s patient, kind and positive.  He gives our office a flow of happy energy even when we’re giving shots and tending to lots of sick children. 

At the end of the day, I enjoy the debriefing and stories we share.    Even the days when I’m irritated with him, I know he has my back, our vision for the business is similar, and how hard we both work to pull this all off.

Loving Pediatric Medicine – the anti-rant

Reason Number 29:  Out of the Office

My partner ran an errand at Target during lunch.  He lives about twenty minutes from our office, and usually uses a different discount chain.

“I ran into four different families who come to our office!”

“Did they recognize you?”  I asked.

” Yeah and each had a story to tell me.  I don’t know how you get any errands done living here.”

Well, actually I do get my errands done, and I enjoy the mini-celebrity that comes from being a pediatrician in a community.  Seeing patients and their parents in their activities adds another layer of understanding to their care.  It’s networking on an informal basis, too.  Some of those trips  give me clues to family dynamics.  The hug from a favorite patient in Chik-fil-a is just icing. 

The early days of motherhood and shopping with young children were challenging.  I felt that I had to wear both mom and pediatrician hat when I was in the grocery store.  All the advice I gave in the office had to be followed  to the letter in public.  My children added a very human (and mischievous) element to my attempts to model good parent behaviour. I still feel that obligation although it doesn’t feel as weighty as it did when my children were in the 0-5 ages. 

If I’m seeking solitude and privacy, I wander to stores outside of my practice “catch” area.  Even then, I can be pleasantly surprised when a little hand taps me on the leg to say hello.  By and large, parents are very kind about asking me medical information when I’m out in public.  I appreciate the division between office-life and out-of-the-office life, and patients do too.  Still, a smile of recognition, a wave of hello, and a tug on my shirt can make an otherwise ordinary day memorable.

Loving Pediatric Medicine – the anti-rant

Reason Number 22: Tricks of the trade. Let me define what I mean by tricks – skills gained by experience – not pranks or deceit. A great deal of rapport with children lies in the trust they instill in me as their doctor. So pulling a fast one on a three year old can do a lot to dismantle the sometimes fragile bridge between us. Being deliberate and truthful with all ages of patients goes a long way for me.
One of my favorite aspects of pediatrics is the first hospital visit after a baby is born. Often, relatives and friends gather in the room of the new parents. After introducing myself, I like to scoop up the newborn under the arms supporting the baby’s buttocks with my other hand and gently bounce the infant. Many times, the baby will open his or her eyes and regard the well-wishers. For some parents, this is the first opportunity to gaze into the eyes of their child. This same technique calms crying babies, too, so it is helpful on return visit when new parents feel sleep deprived and frazzled. The bounce helps me determine if a baby wants to be held – those babies quiet quickly when moved up and down – versus a hungry infant who needs to be fed. Bouncing babies also helps waken a sleepy baby as most are in the first 24 hours after delivery.
Mary Poppins sang about a spoonful of sugar helping the medicine go down. I’ve found that to be true. Prednisolone syrup tastes pretty bad – no matter how sophisticated the flavoring. All have a slick, oily aftertaste that makes me gag and many children vomit. Liquid amoxicillin-clavulenate and cefpodoxime are also poor in the taste category. Chocolate syrup is my go-to spoonful of sugar, but I have the occasional patient who doesn’t like sweet tastes or chocolate. For these I usually suggest chasing the medication with a teaspoon of barbeque sauce. To be a good “chaser” for medication – the flavor needs to be dense with a thick texture. I’ve suggested honey-mustard sauce and ketchup. Ranch dressing also gets a nod of approval.
Do you have a trick of the trade to make your job in medicine easier? E-mail me @ momwithastethoscope@gmail.com and I’ll devote a future post to your ideas.

Loving Pediatric Medicine – the anti-rant

Sea otters hold the world's record for densest coat with 650,000 hairs per square inch. They are a protected species after being hunted for their pelts in the 18th and 19th centuries.

 

Reason Number 17:  Hair. 

“He had more hair than you would think a single skull could hold.  His hair – blue-black, thick and straight - it did not have the hard sheen of the hair of the Chinese or Japanese but had the soft look of fabric.”

About Julian Singh in E.L. Konigsburg’s The View From Saturday

“Hair is vitally personal to children.  They weep vigorously when it is cut for the first time;  no matter how it grows, bushy, straight, or curly, they feel they are being shorn of part of their personality.”

Charles Chaplin, My Autobiography. 1964

“And forget not that the earth delights to feel your bare feet and the winds long to play with your hair.”

Khalil Gibran

Toddler curls that cascade and rebound when tugged.  The brushy feel of a new summer buzz cut.  Silky, inky braids. A shock of  dense hair on a newborn.  I love the endless variety of color, texture, and length of hair on children.  I make it my professional responsibility to examine  a patient’s hair during a physical, but secretly, playing with all the different strands is a marvel.

One patient in my practice is recovering from Alopecia universalis.  At the onset of the diagnosis, I felt I was in mourning  and panic each time she presented to my office.  Her pre-diagnosis hair was lovely shoulder length blonde.  It was the type of blonde that we adults strive for - bright strands intermixed with tawny like the sun knew what it was doing each time it touched her head.  I referred her to three different dermatologists in hopes that one would have a new protocol for stemming the loss of this patient’s eyebrow, scalp, and even nostril hair.  Despite the collective efforts of her mother, myself, and the dermatologists, my patient lost all of her hair.  She has handled the course in the face of uncertain prognosis with grace and a great wig.  Eight months later, small tufts are beginning to come back.  

Once a mom came to my office with her preschooler, and she told me that she knew the child was sick because her hair wasn’t right.  It turns out she was right, so maybe I’m on to something by examining the ringlets of infants and the swath of hair covering the eyes of the young teen.  Maybe it’s not just curious fascination, but yet another clue to the inner workings of my patients.

Loving Pediatric Medicine – the anti-rant

Reason Number 6:  Pain.  I am anti-pain, and I try very hard to make my patient feel less pain.  Acetominophen. Ibuprofen. Otocaine. Occasional Acetominophen with codeine.   My own threshold for discomfort is pretty high, but I am sensitive to the varying levels of hurt.  This is not to say I have no radar for abuse of medications – I do. 

Sometimes relief is immediate – which is very gratifying, and sometimes relief comes in the form of sleep.  The know-how to relieve suffering should be innate to physicians, but sometimes, it isn’t.

Loving Pediatric Medicine – the anti-rant

Reason Number 2:  Tickling the bare toes of an otherwise wary eighteen month old patient, and getting a giggle.

Loving Pediatric Medicine – the anti-rant

Reason Number 1:  Absolutely enjoy working side by side with RNs, CNAs, MAs, and administrative staff  who share my passion for children & preventative medicine.

Overheard…

“I’m too sexy for my carseat.”

5 year old patient @ check-up

More Car Chatter

Somewhere between kite/toy store and candy store on the East Coast:

“I quit drinking Mountain Dew Code Red because it decreases sperm production.” said Will, age 12.