Category Archives: PEM Fellow Perspective

The world the Pediatric Emergency Medicine Fellow is quite different from that of the resident or the attending. This column will help us appreciate the unique perspective of the PEM Fellow.

Find your Coach’s Cap

Michael Greenwald, MD
Associate Professor, Pediatrics and Emergency Medicine
Emory University/Children’s Healthcare of Atlanta

Physicians wear many hats. At times we are teachers and other times psychotherapists. We are asked to diagnose and also to counsel. With experience each of us learns when to switch hats. But there is one important role that we sometimes fail to recognize and embrace: the role of “coach.”

Coaching is very similar to teaching but there are important differences. read more

Children’s National Health System Fellows Blog

Author:  Mohsen Saidinejad, MD, MBA, FAAP

The fellows at Children’s National Health System have developed an open source academic blogsite, which includes various areas of interest to fellows and attending PEM providers.  A weekly “Hot Seat” case, which enjoys tremendous popularity, evidence-based articles with large impact on PEM practice, and a one-of-a-kind ECG training module are just some of the resources that can be found there.

The blogsite was the original creation of Sonny Tat, MD, a former fellow at Children’s National and a current PEM faculty at UCSF.  Sonny is also the site administrator for PEMNetwork. read more

Welcoming Spring as a new mom

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

A Day in the Life of a PEM Fellow

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

What’s on your mind?

HPI: A 15 year old female with a history of ADHD and anxiety was brought into the emergency department by her parents with concern for a change in mental status. The patient had been seen at an outside facility the day prior to presentation for a separate diagnostic workup

She had complained of dizziness that day, and some subtle shaking of her left upper extremity.  Mom and patient were not initially concerned since the patient had been known to have shaking of her legs at baseline. After returning home from her appointment, the patient fell asleep on the couch and did not awaken for the remainder of the evening. On the morning of presentation, mom reports that she was still unable to awaken the patient. The patient was very weak and had difficulty bearing her own weight.  Her speech was noted to be slurred and largely unintelligible. read more