Baptism by Fire

My first rotation is pediatrics, with one month of outpatient pediatrics at Santa Clara Valley Hospital and one month of inpatient pediatrics at Packard Hospital. The day started off with a nice orientation in the peds offices at Stanford. We had to say one unique thing about ourselves, and since I was the first to go and couldn't think of anything clever, I blurted out that I had a newt. And then I had to explain why I own a newt, and that I had to feed the newt live worms until I persuaded the critter to eat pellets, and altogether, it was way too much information. So now my colleagues all think I'm a herpetologist freak. Great.

After the orientation in the morning, we went off to our sites. After a brief (i.e. 5 minute) orientation at the Valley, they told us to go grab a patient and get the day started. Two of the other students had already gone through clerkships, so they actually knew how to see patients and properly interview them. My classmate and I looked at each other with fear in our eyes. This was our first hour of our first day of our first month of our first clerkship ever. We had no idea what to do.

In fact, I kind of just froze up. After only interacting with board review books, the computer interface of Kaplan Qbank, and my trusty thermos of tea for the last several months, I think I've completely lost whatever minimal social skills I had before I started studying for boards. I had no idea how to talk to normal people anymore, much less crying and sick five year-olds and their anguished parents. Luckily, the attendings sensed the fear in the air, and we ended up spending the next hour shadowing the attendings.

But the halcyon days ended quickly, and we were gently told to leave the nurturing nest and to test out our wings. I grabbed the first chart on the list, and I saw that my patient was a 5 day old baby girl here for just a weight check.

I figured that I could handle this. Weighing a baby isn't too hard. I jauntily stepped into the room with all the naivety of a fresh-faced third year medical student. I greated the family (mom, dad, two brothers), and pulled out my arsenal of pediatrics pleasantries that I had watched on the training video the night before (apparently, Tickle-Me-Elmo is the way to go, little kids love Elmo and always stop crying when they see the fuzzy head peaking out of a white coat packet). Of course, the five day old baby paid me no attention whatsoever. I asked what I could ask about bowel movements, feeding habits, etc of the baby, but really, I ran out of questions after about 46 seconds. I then smiled awkwardly and asked the parents if they had any questions--my favorite stalling tactic.

Since the chart said the reason for the visit was to weigh the baby, I figured that I could manage that. So Daddy and I plopped the baby unto the scale, and with lots of hums and hmms and all the gravitas I could muster I recorded the weight of the baby.

I thought my job was done. I went to my attending with confidence that I weighed the baby in an irreproachable manner. What ensued was a hour-long teaching session of all the things I should have done. Apparently, they were concerned about the baby's bilirubin levels, and I had to go back and track all the bili levels and then plot it on the Bhutani curve. And then I had to calculate the change in body weight from birth to discharge to today and figure out if the baby was gaining enough weight. And then I had to figure out if the mother was making enough milk. What I thought of as simply measuring the weight of the baby became an all encompassing check-up of the baby. Luckily, the attending was extremely patient, and took an hour out of her busy day to walk me through the proper management of a baby who wasn't gaining weight and the proper monitoring of bilirubin.

The most confusing part of this initial patient encounter of mine was right when I first walked in at the beginning of the H&P, the parents informed me that the baby's belly button had fallen off. I thought I misheard them and asked them to repeat it, and sure enough, they said the baby's belly button just fell off. Incredulous, I inched closer to the baby and with a sigh of relief pointed to the very much present belly button on the baby, and continued on with my merry H&P.

As I was about to step out, the parents held out a little black nubbin in their palm. And then it clicked! That was the belly button they were talking about! I sort of freaked out. In all my years of schooling, it never occurred to me that the little stump of the umbilical cord falls off a few days after birth, leaving behind the belly button! In my pristine understanding of the world, I thought babies emerged with cute little belly buttons.

So I rushed to my attending screaming, "The belly button fell off, the belly button fell off!" She looked at me, shook her head, and I thought I heard an audible sigh.

That concludes my first day of my pediatrics rotation. It is remarkable how much I learned this afternoon. I'm looking forward to the rest of the rotation. Next week, I'm heading to juvenile hall to rotate through the clinic there. Don't lose your belly buttons.