It was really socked in, a complete white out on one side and with fluid too. She was transferred from a local outlying hospital, full of Rocephin and waiting a possible chest tube. But hanging out in the ER in the mean time and acting cranky. Just like sick kids do. Except she didn’t look all that sick.

My exam was finished and the intern was finishing her excruciatingly long admit note. We always over write when we are  beginning and I let her just write and write. I knew she needed the practice.

I turned on some cartoons.

She asked me for a drink of water.

I wandered off and brought it back just in time to hear her father say,  “Mommy says she loves you and she’ll be right here”. Her Father hung up the phone, rolled his eyes a little and smiled, “Her Mother spoils her!”

I smiled and left them alone. She was stable with normal vitals and I needed to head upstairs to pump milk for my 6 month old baby girl.  That was life at the end of my residency: In between caring for my patients, I would pump breast milk and dream about seeing my Little Miss Blue Eyes after slugging through 36 hour shifts.

Life had changed a lot since becoming a mother – I was learning to multitask more.

Sitting in my quiet little call room, I settled in and started flipping through a magazine while the rhythmic “Vroom Vroom” of the pump droned on.

*Knock*  * Knock*

I turned off the machine, “Yeah?”

“Hey! Sheila! They’re coding your kid downstairs”

“Huh?”

What took me many carefully maneuvered minutes to put together… was detached in seconds.

“Did they start the chest tube or something? Was there a complication?”

I stepped out the call room and into the open hallway. I slung my red stethoscope around my neck and took off.  Running as fast as I could I tried to get to her .

I rounded the corner and found that she was already in the Resuscitation room. I boldly opened the door. I wasn’t going to knock. I didn’t have time for that. I mean it’s my patient I needed to be in there.

So in I went.

8 people stood still, surrounding her, their faces blank. She lay there unmoving. Grey, with a tube sticking out of her mouth. As if in slow motion I started to move toward her, “She needs oxygen” I thought.

I stopped as the head ER attending called out,“I’m going to call it. Does anyone have problem with that?”

My eyes grew wide and I just stood there.

Stunned.

“Time of Death 3:35pm.”

Later, I was told that she was just watching the cartoons with her mother, when she sat up suddenly and said, “I see colors.”

She stopped breathing.

And never recovered.

She grew out Group A Strep in her blood – septic from the pneumonia.

She’d be 13 by now. I think about her more than any other patient.

Her father is a physician. No-one blames him. She looked good to him, to me, heck to all of us. No one could have predicted it.

And no one has ever forgotten.

This is for you Baby Girl.

It was exciting to do some of the research. I let the dishes sit and went exploring on the internet. I’ve always really liked genetics. It’s one of the main reasons why I chose pediatrics. It’s an opportunity to get at the beginning stages of a diagnosis. Frustrating but pretty cool.

Now here’s you chance to tell me something…

What color are your eyes?

Mine are green.

I never interviewed other doctors. I didn’t know doctors when I grew up- except for my family practitioner. All I remember about him is he was a gruff that never talked to me and who ripped off my bandages without so much as a warning.

So if your reading this you may have asked the question: Should I be a doctor? And to that I say,

Don’t ask me. Ask yourself.

• Could you see yourself insanely happy, fulfilled doing something else?
• Do you gravitate to medicine?
• To people?- I mean this seriously! Do you even like people? Or do they irritate you?
• Do you like the mystery?
• Are you willing to pursue it above all else?
• Do you like being needed. – Cause if you can’t stand the clingy person who is scared and needs lots of reassurance then don’t do it. It’s not fair to the one who needs it or to you who will be drained immensely by their questions.
• Would you be happy doing anything else in medicine? There are a lot of really important people needed as a Physician Assistant, Nurse? Radiology Tech?
• Would your life handle medical school right now. It’s 4 years of all out studying and sleepless nights.
• Are you married? And will they support your decision? Though some people in my class were married the majority weren’t. You need to have incredibly supportive people surrounding you. Because honestly you may be ignoring them (even unintentionally) a good deal of the time.
• Do you have kids? The majority didn’t have kids. And the ones that did had wives to pick up the bulk of the work. The one women who had a child started the year before me and just finished her residency this past summer. That’s a total of 12 years and 4 kids later.  – Don’t let that discourage you though. She did it her way and she has a healthy happy family. And she a wonderful doctor.

If you answered I don’t know to any of these then think about all the medical stories you have heard. Did you wish you were there? In the action.  If above all else you want the buck to stop with you. Then pursue on.

Don’t worry about all that you read – even my other post- The Ugly Side of Being a Doctor. That’s not all it is about.  It’s not just about the pain.

• Being a doctor is not about declining reimbursements.
• And the sleepless nights.
• It’s about hope.
• It’s about people
• Sick and well.
• It’s about not knowing.
• Watching families grow up.
• It’s about 3am calls.
• Delivering a baby to a gleeful family. Shining tearful happy faces.
• It’s about knowing you can do that job.
• Being around people, for them and about them.
• It’s about always knowing you can do more.
• And being willing to do it.

So the very last question you need to ask yourself is….Are you that person?

Make sure you go and take a look-I’ll be talking about making medical decisions regarding your child. I seem to be addressing this very issue myself. Is it the right thing to do? Is it overkill? 

Today a parent struggled with my medical decsison and I had to be pretty firm that in this particular case we needed treatment. They paused and still didn’t believe me. I know how they feel. 

What about you?

Do you ask your doc?

Your mom?

Your sister?

Do you visit chat rooms or peruse the internet?

9:30- Patients trickling in but still being triaged. I’m finishing notes from yesterday. 19 charts to go. An extra  11 charts sit next to me to review.  So is a coffee cup with- no not coffee- water. Hmmm…Keeping the stories straight can be challenging.  Ooops- off to room 3.

9:50 Still with patient number one. Need to talk with another doc one to one. Never mind they can see her tomorrow. Thank Goodness. Off to patient number two.

10:15 Twin physicals down. Now I’m even more behind.

10:00 I give up and stop charting as I go. I’m later than late and it’s important to keep the clinic flowing. I make sure to write down what’s abnormal on exam and their diagnosis and the plan. I’ll have to go back later to fill it in.

10: 35 Patient #7 walks in with respiratory distress. Solu, albuterol and we wait. Then patient Number #11 walks in with same exam. It’s bronchiolitis season.

12:15 Cleared out those charts sitting next to me. Two are still waiting there. I need to do some research on current therapy.

12:40 Done with morning clinic- 2 patients are still getting nebs. Pt number 7  is hanging out. Will be repeating nebs and exams and trying to keep her from being admitted. Patient number 11 seems to be worse too. Time for some rocephin and another treatment. I now have 20 minutes to finish my charting from this am and yesterday and then afternoon clinic starts.

12:43- I eat lunch and power through only 9 charts. Ugh.

12:50- My one o’clock two week old comes in. After he’s triaged I spend some extra time him. Sibling died at 6 months of age.  Now I’m really behind and the afternoon just started.

2:00-Another bronchiolitic comes in for follow up. I consult ENT for the stuffy nose and then send the parents out to get: Afrin, Nasal saline and Dexamethasone Ophthalmic Solution. I await their return and give albuterol nebs to see if it helps. It doesn’t really.

3:06- Number 7 and number 11 are finally discharged. Strict instructions to follow up the next day.

3:20- Another little boy in a long list of little boys comes cruising in. The mom looks so delightfully rested and beautifully attired that it makes me want to go take a shower. Or at least brush my teeth.

3:35- My staff is standing around waiting for me to clear a room so they can do something. I’m the rate limiting step. They tell me-  In case I don’t know- that I have a full waiting room. I nod my head in acknowledgment and keep on moving.

4:00- My staff asks me if I need help. I say no. They ask me if room three is done. I tell then I can’t remember who is in room three. I have to peek my head in and see. Ahhh yes I remember. They can go.

4:40- I can hear the door ringing every time it’s opened. I don’t know if they are coming or going. All I know is my exam rooms are full and it’s still standing room only in the waiting room.

5:00- I wonder if my husband is home and preparing dinner for our three kids.I decide to admit little stuffy nose to the hospital. Despite the ENT concoction she still tugging hard.

7:30-The last patient walks out the door. We all breathe a sigh of relief. I wonder how many I have seen but I’m too tired to count. No charting has been completed. None. Zip.

Highlights of the Day

A lollipop red tongue that then sings me, “Tweeeenkle Tweeeeenkle little Star”

Dodging a perfectly arc’d urine stream in a follow up circ.

Twirling a pigtail into one long spirally curl. The grandmother and I launch into a discussion about how you just can’t get good Shirley Temple movies anymore.

And for the umpteenth time I have the following discussion:

“So you’re not going to give her antibiotics.”

“No.”

“Why?”

“Because as  far as I can tell she has a virus. If she’s still febrile in 2 days please bring her back.

“So I have to come back?”

“Yes.”

“You’re not going to give her anything”?

“No.” ( I say this as nicely as possible- just in case you were thinking that I was being mean)

8:15- I’m home. I tiptoe in and kiss my sleeping children goodnight. My husband and I discuss the kids. Did Miss blue Eyes get her homework done? Did Smiling boy get his iron? And his antibiotics? Did they eat ok? Go down okay?

9:55- I finish my blog post and crawl into bed. Tomorrow I’ll go in early to chart.

I never WANTED to be a doctor. That would be too bold for a C-average kid to imagine. It might be fine for the valedictorian or the genius that aced the SAT’s years before they were actually necessary but for me? It wasn’t part of the picture.

BUT what I did do was follow my interests. I watched M*A*S*H religiously and then Doogie Houser and Then ER.

I camped out in the library during freshman and sophomore year in high school and read autobiographies and kids with diabetes and other chronic illnesses.

After high school I got a job with developmentally disabled adults instead of McDonalds.

When I choose college courses I gravitated to biology and thrived when they spoke about medicine and illness.

When I finally got out of my own way and used Mind Mapping to study,  when I got my grades soaring and then a little while later got my confidence  soaring, I stopped worrying that I wouldn’t get in. When my father said “You can do anything you want” and I finally thought it was true and not just a line a devoted father says to his little girl.

And one day I just asked If  myself if I could see myself being a doctor and was I interested in it?

The bold fact was YES.

Once I decided on medicine. Nothing else entered my mind. Everything that I did brought me closer to that goal. Summer internships, volunteering at the Children’s hospital, traveling, writing essays, lecturing across campus on HIV/AIDS/birth control, heading the health clinic at the college heath center, working full time with a independent living program for DD adults.

A few years later I walked into one school interviewed with one guy and was accepted.

And here I am.

And now I know that putting on that white coat and draping the stethoscope around my neck isn’t enough. Studying biochem and surviving the OB rotation isn’t enough. Placing MD after my name isn’t enough.

Being a doctor is about healing. And most of all that means healing ourselves.

Today took the cake.

I saw anaphylaxis in action and it wasn’t pretty.  He was struggling, gurgling, drowning in his own saliva. Bright red skin head to toe covered in hives. Wheezing and congested. In clear respiratory failure.

I called out, “I need Epi!”

The gurgles increased and he grew pale. His airway was closing. I was running out of time. I glanced over at my staff. They were working quickly but the epi wasn’t drawn up yet.

Without hesitating I walked over to my purse and grabbed the Epi pen jr ( I carry one around for my son in case of an emergency.)

Flicking off the gray protection cap I strode quickly back to his room, took his outer thigh in my hand and stabbed the pen in his leg .

*Click!* it went. What a satisfying sound. As I held it and counted to ten I looked at his face. Within seconds I could see him suddenly relax and breath easier.

It took another Epi dose, IM  Benedryl and Solumedrol before we could leave to hospital.

Later I sat in the cab of the ambulance listening to the sirens screaming as we moved easily in and out of  traffic. Surreal.

And I thought today’s highlight was going to be taking Little Miss Blue Eyes to her first day of school.

*** I just fell asleep on my computer- I’m off to bed. I’ll get those pics up tomorrow and you can see what a sweet and happy first grader I have.

Oh and that baby- stable in the PICU right now. Thank God for Epinephrine.

I went over to visit Dr. Cason’s site and while I see a ton of information informing parents how to be a good, normal parent, I fail to see the part where she addresses anything that even comes close to what so many of us live with everyday.

Ouch.

It’s true. I try to be light. Have some fun. Life a bummer and sick kids are tough. I don’t dwell too much. But here’s the thing. I never forget. But it might seem like I do. So I’ll let you know what I ruminate over in the quiet of the night.

Here’s the ugly side of being a doctor. The side I don’t talk about. I run the risk of sounding all important and self absorbed. But trust me I’m just like you all.

Warning some not so positive stuff about to unfold.

1. I never wanted to be a doctor.
2. I wanted to be a writer.
3. But here I am.
4. The buck stops with me.
5. I’m in a war zone here.
6. I’m not in the war.
7. I just watch it.
8. And try to stop it.
9. There too many dead children on my mind and in my heart.
10. You can delude yourself into thinking you are helping someone.
11. That what you do actually matters.
12. But the truth is.
13. People live and die and life goes on.
14. I was baptized in Medical School.
15. I pray because it’s the only way I can stop crying.
16. I go for runs and pray.
17. I pray for the two month old dropped on her head.
18. She herniated before my eyes.
19. I pray for the  two year old who drowned in a neighbors pool.
20. He came in on the same shift as the baby.
21. We celebrated his 3rd birthday.
22. And then disconnected his ventilator.
23. His mother thanked me for crying. She said it was nice to see someone who cared.
24. I pray for the baby found dead next to his sleeping mother.
25. I stood poised with ET Tube as the ambulance approached.
26. He was gone too long.
27. I pray for the abandoned comatose girl in the PICU.
28. I  gave her a sponge bath, combed her hair and put in little braids.
29. The nurses wrote me up.
30. It seems doctors aren’t usually that nice.
31. I’ve cath’d babies, tapped them, intubated them and helped harvest their organs.
32. I’ve watched a quivering heart be placed in a cooler and flown away.
33. To help another life.
34. I’ve called codes, ran codes and run to codes.
35. All holding my pregnant belly as Gabby jostled around.
36. I pray for the seven year that died within minutes of my exam.
37. She was talking.
38. I got her a glass of water.
39. She was stable.
40. She smiled.
41. “I see colors” were her last words.
42. I pray for the baby with the gray tummy.
43. Perfect little peanut until I rolled him over.
44. I pray for the 22 week old preemie.
45. The parents begged me to save her.
46. But I’m not God and I can’t grow lungs.
47. I’ve struggled with my team to save a newborn
48. When it was apparent that I COULD NOT DO ANYTHING
49. I turned and RAN. Down the hall.
50. That baby needed his mommy to hold him as he died.
51. That Mommy needed to hold her baby as she said goodbye.
52. I pray he found peace.
53. And she too.
54. I pray for the four year old I diagnosed with cancer.
55. As his father clung to me he cried
56. Please help us.
57. I pray for the 5 year old immigrant who was rescued by his grandmother in TJ.
58. Left alone for days then stolen by drug lords. Repetitively.
59. He cried when I examined him.
60. Afterwards I held him.
61. Shhh Shhh Shhh I cooed . He felt like my sweet kids.
62. He wouldn’t let me go.
63. So I carried him from room to room.
64. I pray for the 14 year old boy who cried in my office just last week.
65. I knelt down and said I understood.
66. But watching the war is not the same as being in the war.
67. I’m in the war with my son.
68. I pray for him repeatedly.
69. I prayed when they scoped him, poked him, prodded and took his blood.
70. I prayed when I heard those words- Immunodeficiency.
71. Hmmm how interesting I might say any other time. But not this time.
72. It’s not a book or a case
73. It’s my son.
74. I feel the desperation.
75. He’s coughing now.
76. I am a doctor.
77. I owe a quarter of a million dollars in medical school loans.
78. I fear my debt will outlive me.

So maybe I can’t come close to what other feel but I try. I know that as a doctor, I’m on the better end. I can’t even imagine the pain of those parents. But it doesn’t mean I don’t care or can’t relate. This is not a “job” for me. It’s my life. I’ve resuscitated babies in a Walmart and a pizza joint. I’ve run to  multiple car accidents and performed the Heimlich in restaurants. I answer  questions daily for readers, friends, neighbors and strangers. I keep a otoscope charged in my kitchen. I make house calls and advise friends. I have two websites. I make no money but dream of funding humanitarian missions. Because I have time and medical knowledge, I hope to use it well.

The ugly side of medicine it what it is. I didn’t even come close to all the other terrible crushing memories. Some are fading some not.  Don’t worry. I’m not crying right now.

1. I’m happy.
2. I like what I do.
3. I can sleep at night.
4. I took an oath and
5. This is my calling.

Welcome to my first Medicine Monday! This is where each week I post the answers to the questions I have received in the previous week. Some of the questions come from my readers and some from my clinic. Believe it or not I frequently have to admit that I need to do some research and get back to them!

Yes doctors look stuff up all the time and if they are not looking something up maybe they should!

Here we go:

Question #1:I have a healthy 16yo girl who bruises very easily. I mean if you touch her hard she bruises. She has been like this from the get go. She regularly has at least one or two and cannot remember how she got them. I was wondering if this means that she may be deficient in something? Any clues?

Answer:For most people bruising is a sign that there has been some damage to the underlying tissue. You run into a wall, you get a bruise. Reducing the injuries reduces the bruising. Easy peasy. BUT very rarely there can there be something wrong with the platelets or the body’s clotting factors. Why this is could be genetic or a side effects of a more serious illness. If you notice that your child bruises easily without any associated injury you should make an appointment with your doctor. There are some simple blood tests that can put your fears to rest.

Question #2: Is there any way to get a two and a half year old to stop sucking his thumbs? Harry is a hard core thumb sucker and is just healing from a very nasty blister that he gave himself. I was about ready to take him to the doctor from fear of infection when it started looking better and a lot less icky. This is not the first time that he has injured his thumbs and I naturally worry about it. Any tips? Should I wait it out since he is so dearly attached to sucking his thumbs?

Answer:Awww how sweet. I’m actually not a big believer of creating a lot of drama around the thumb. I have two thumb sucker children and I just let them be. Most dentists will say get rid of the thumb by age 4. And just how we do this I’m not sure. There are some bitter things you can put on the thumb but I haven’t tried this. I actually believe the thumb serves a necessary coping mechanism for some kids and I would say help him learn to cope using other methods as well such as a blanket or special toy.

Question #3.Is it better to treat iron deficiency before the child becomes anaemic or is ok to wait until the haemoglobin drops? Ivy’s MCV and other stores are low and dropping but she is not yet anaemic.

Answer:I would check Ivy’s iron levels and ferritin. You could then see if she might benefit from additional iron. But if she’s not anemic and her iron stores are normal don’t treat. Here is more info regarding iron deficiency anemia

That’s it for now. Next week we’ll talk a little about imaginary friends. It’s a question I recently received from a family I see in my clinic. What about you all? Have you had an imaginary friend? Or rather did you? What about your children? Anyone invisible hanging around lately?

Poor baby. We wrestled with her fearful self and managed to throw in three sutures. She’s going to be fine.

All in all I ran nearly two hours behind. I know. I felt guilty.  I’m so sorry. The last patient- no kidding – waited over two hours for an earache and I found nothing on exam. I peered and poked took a good history and then apologized. Sorry, nothing.

I hate running late. I get all jittery and worn out.

So I’m off to an early bedtime. Unless I watch Moonstruck-which I recorded on my DVR. Nah maybe I’ll just read a bit. Tomorrow I shall show the black and white photo. I can’t help it. I really love the contrast!

Tell me do you forgive us? Us chronically late docs?