Maybelle Kou MD, Fellowship Director, The Altieri PEM Fellowship at Inova Children’s Hospital.
For some medical educators June and July can conjure up feelings reminiscent of Bill Murray’s character in the movie “Groundhog Day”. You’ve probably laughed at the scenes where he goes to extremes of self- injurious behavior before waking up the next morning in exactly the same place. No matter what time of year, this can feel like a daily ritual in the Emergency Department. The environment is massively complex with patient and practitioner variability, team interpersonal dynamics, regulatory and local administrative mandates, all of which contribute to the chaos. Add workforce regulations and it seldom seems as though one works with the same learner more than once or twice during a rotation.read more
We have finally recovered from the Big Snow in DC! I hear another front is approaching, but on significantly smaller scale.
Our PEM fellows attended the DC/MD/VA Regional PEM Fellows conference this fall. It is an annual event that rotates between the campuses of the Inova Children’s Hospital, Children’s National and Johns Hopkins University Pediatric Emergency Medicine Fellowship programs covering topics in leadership, teaching and communication. Dr. Manoj Jain was a featured speaker at the 6th annual conference this past October.read more
In a matter of seconds, life can change from one extreme to another.
Some recent examples that come mind are:
A 4-year old boy wearing Superman pajamas, just diagnosed with a brain tumor.
A 9-year old girl who is scared of doctors, diagnosed with acute appendicitis and in need of surgery.
A 12-day old boy with persistent fussiness with HSV meningitis.
A 13-year old girl playing Candy Crush on her iPad with new-onset diabetes.
A 17-year old boy taking a Calculus final exam in school found unconscious. He was in ventricular tachycardia.read more
As we head into spring this year, I let out the biggest sigh of relief that we have passed the peak of RSV season. Somehow my 7 month old, who was a mere 2 months old when the bronchiolitis patients started trickling in, has come out the other side unscathed.
It has been year of new demands, learning to balance the needs of my very new, very dependent baby, with the challenges of being a fellow. Each time I disappear for 15 minutes to pump, I might miss an incoming sick patient, or delay a child’s disposition. When I stay late to finish charting, or supervise an intern suturing, I risk missing the bedtime ritual, or worse, arrive home to a very hungry, very grumpy baby.
My son arrived two months into fellowship, and within 2 weeks of my return from maternity leave, our ED had its first Ebola scare and my husband and I had to think about what to do about breastfeeding in the unlikely event I came across a case and had to be quarantined. In November, for the first time since my intern year, I picked up a viral URI from one of my tiny patients that lingered at least 3 weeks, and I had to worry about getting my face too close to my baby’s. By some miracle, and thanks to a strict adherence to an after work disinfecting routine, my son giggles on, with nothing more than occasional sniffles. He hasn’t even ever mounted a fever in response to a vaccine. And now, I must pause to knock on wood as hard as I possibly can.
At times, the jobs of being a new mother and being a new fellow are at odds, and I feel stretched thin balancing the needs of my little boy, and my need to protect him, with the needs other, sicker children at work. Nearly every day though, each of my two jobs makes me better at the other.
As an emergency medicine trained fellow, I am, for the first time, intimately familiar with bilirubin normograms and vaccine schedules. I can guesstimate appropriate acetaminophen doses from across the room. As a new mother, I can identify with the sleep deprived haze that might foster a near panicked visit to the ED to find out if it really is normal to cry that much, or if that odd facial expression was a seizure or just gas. In residency, when asked a question that clearly fell into the realm of parenting rather than medicine, I’d be quick to defer to the pediatrician. I finally feel I have legitimate advice to offer.
There is such a nice synergy right now, learning to take care of my own baby while I learn to take care of so many others’ as well. My two new jobs will continue to stretch me, often from opposite directions, but I am so glad I chose to start both. And in the end, I think just maybe, they will be worth all the sleep I’ve had to give up for them.read more
I look down the signout list in preparation for the day. My heart sinks and I feel myself sweating. Palpitations ensue and I have to stop and take my pulse and an aspirin. No, I’m not having a cardiac arrest. At least not yet. The patient in room 1 stole that thunder already.
Am I back in the adult ED again this month? Nope! PICU is the flavor of the month! Back into the world of rounding for hours on every system of the body, discussing vent settings, sedation drips, whether or not to diurese, whether or not to feed, whether or not to extubate; and yet all of those things are not why I opted out of doing a PICU fellowship. The medicine is great! I love a challenge, and these patients are certainly not disappointing me in that way. I am in way over my head and being inundated with a dictionary of words from a language that I have not used in several years. So why the heck am I so exhausted when every day is a steady adrenaline rush?read more