2 weeks down ... 7 more to go.

Some cool things happened this week.

I detected a heart murmur that no one else had heard (I owe it all to my Harvey Elite stethoscope, which has become an extension of my brain). The boy is about 9, and there it was ... faint, but present with an almost musical tone, 'hmm dub, hmm dub, hmm dub'. I told my preceptor and she said she doubted it, that no one had ever heard a murmur in this patient before. I stood silently as she listened carefully, then she rose and explained to the mother what a murmur meant in this case (most likely an atrial septal defect that hadn't yet closed, but which probably would in time).

I solved the case of a toddler's constipation. The parents disagreed that her belly was distended, but it plainly was. I asked if there had been any change in her diet? No, they said, she's still on formula. I palpated her abdomen and then turned around and asked, "are you feeding her formula that's been supplemented with iron, by any chance?" They looked surprised and said that yes, that had been the kind on sale the last time they shopped. Well folks, guess what ... that iron has constipated your beautiful baby girl. Based on how lumpy her guts felt, I was surprised she wasn't a bit more cantankerous ... I sure would be!

A young teen, about 14, had been 'forgetting' to turn in her homework. She had been doing it, but it was staying in her locker. Oddly enough, her mother said that her memory was fine in other areas, such as when it was time to go swimming with friends, etc. My preceptor understood that it was rebelling and gave her a little talk on the importance of education and that she needed to ship that into shape. The mom was nodding and agreeing vigorously, and the young lady was just sitting with her head down, dealing with the barrage. When they were done and there was a moment of silence, I said, "may I make a suggestion"? All eyes turned to me, I think they had forgotten that I was in the room. I looked directly at the mother and said, "I would suggest that you make sure your daughter has some more room in her life to make her own decisions." It was obvious to me that she was exerting independence in what was probably the only space that she had as her own ... her school locker. Mom and dad could make her do the homework, but they couldn't make her turn it in ... she had that power and she was using it. "I don't know you well enough to say how, but maybe you could think of another part of her life where she can exert her power to say no, I don't want to do that, or yes, I do want to do that." The mother stuttered and sputtered a bit, because she wasn't expecting to be put on the hot seat. But based on the fact that she had mentioned earlier how the situation was creating a lot of stress and strife at home (yelling, fighting), it seemed to me that there was an A + B that was leading up to the C (which was probably the grade her daughter was headed for, if things didn't change). My preceptor spoke with me later, agreeing about my comment and the situation, and she's been treating me a bit differently since that day. I've always had an affinity for working with teens, I think it's important to remember where they are in their development and how important it is that they be allowed to grow (with guidance) into responsible individuals who are capable of making decisions (that they can handle).

I learned the importance of asking about cough when I thought it was simply musculoskeletal pain ... turned out the patient had one, so we sent her for an x-ray to rule out mycoplasma pneumonia, which presents with dry cough that creeps up on you. I'm fine-tuning my newborn and infant exams, no easy task ... it's so easy to look and say, 'oh, the baby looks fine', but are the testicles descended? Is there a hypo/epispadia? Hernia? How are the femoral pulses, to rule out coarctation of the aorta? Any cardiac sounds which could indicate a defect in the heart? Any evidence of a spinal defect? Any retinal hemorrhaging, which can indicate shaken baby syndrome? Are all the neurological reflexes intact and how well is their neurological development? Kids are no easier than adults, and in many ways more of a challenge because some can't talk to you in words.

Other than the little girl who screamed bloody murder because she didn't recognize me (you could easily have heard her down the block, as she sat in the hallway refusing to budge ... man, I didn't know a face could turn that shade of red!), the kids are awesome and I love working with them. The ones who just want to talk to you, even though it's in a language that no one but they are understanding, they're the really fun ones, as are the 6 year olds who just can't wait to tell you all about everything and anything they can think of.