June 27, 2011

hating (a little) on hospitals

that's my backyard
I definitely needed to do some yoga back here after work today
I feel sooo lucky to be living here.

so after my first week of inpatient (meaning, actually in a hospital), I'm not sure it's the place for me. I know that it's only been a week and I've spent most of it running around exhausted, not sure where I'm supposed to be or what I'm supposed to be doing. But is that maybe what a hospital is about? All the big things that infuriate me about our medical system including lack of emphasis on preventative care, running unnecessary and sometimes harmful tests, lack of coordination of care, and dark, dingy places where people are supposed to feel better - all are at their worst in a hospital.

For example, I have one patient who is a 15 year old who just had a bone marrow transplant for his leukemia this past spring and now has low grade fevers that have lasted for a few days. Because he is immunosuppressed (meaning, we've taken down his own body's defenses in the hopes that we can sneak by the new bone marrow and his body will accept it, but it also means we open his defenses to anything else that wants to come in) - we have to make sure he doesn't have any other type of infection - so we are literally culturing every orifice and secretion from his entire body. Plus, even though I'm the person who presents him to the pediatric team - there's the heme/onc team who also has a plan for him and understands his disease the best, the nephrology team who has a plan for him because his kidneys shut down a bit during his chemo, the nutritionist who has a plan for him to maintain his weight, the infectious disease specialist who has made sure we're treating or at least considering every possible type of infection - all of whom come to see him once a day and give him pieces of information.

I see him in the mornings before rounds (around, 5:30am-ish), and then later in the afternoon after rounds and my required lectures, usually around 2:30/3pm. Between those two times, he sees around 10 other people who are changing things about his care, not to mention nurses, chaplains, pharmacy techs, the man who comes to empty his garbage -

the kid is exhausted yet we never give him more than an hour to actually REST. I know we have to check him and that he's in the hospital so we can check him, and that it's good for him to be in the hospital because there's so much knowledge in one place. BUT it still seems to me like a poorly coordinated, unhealthy situation. We think he's infected and we know he's at risk of another infection yet we have 10-15 people walking in and out of his room every day.

maybe I just needed a little rant time. I'm honestly really liking pediatrics - I love thinking about development and the differential at different stages of development. For example, a newborn with vomiting versus a 5year old with vomiting, versus a 10 year old with vomiting, versus a 16 yo with vomiting are all likely to be different things based on the ages. With adults, you have the same differential each time. Plus, kids are fun. one of my other patients is in an electric wheelchair due to a spinal disease and he decided today he wanted to give the staff rides around the hallway, charging us $1 each to sit in a rolling chair behind him and be pulled down the hallway. dangerous? mildly. awesome? definitely.

stay tuned, next week I'm on nights.

"there's a darkness upon us that's covered in light
and the fine print, it tells me what's wrong and what's right
and it flies by day and it flies by night
and I'm frightened by those who don't see it"
-Avett Brothers

1 comment:

  1. I'm with you sister! Well put. And that is my fav Avett Bros. quote. Miss you!