Hello and welcome to another Medical Mondays! I have 4 weeks left of inpatient medicine before…(drumroll…) my vacation! (I’m so excited to see my friends and family again!)
I spent my last 4 weeks on the pediatric floor, and although I’ve done Pediatrics twice before during my med school rotations (once in 3rd year and once in 4th year), I never actually had a chance to do inpatient pediatrics until…well, this past month. Needless to say, there were a lot of things to get used to. Read on to see what it was like!
I used to volunteer in Therapeutic Recreation/Child Life at Shriner’s Children’s Hospital in northern CA (fancy way for saying that I hung out with the kids, read them stories, played video games, and did arts + crafts with them <3 ), but aside from that and my mom’s “Take Your Daughter To Work Day” back when I was 7, I’ve never spent any time in a children’s hospital.
Day in the Life: Pediatric Floor
We received sign-out from the night team during this time. Sign-out was done on a first-come first serve basis and we’d have a one peds intern, 2 family med interns and 1-2 sub-I’s (4th year med students) on weekdays, so there generally wasn’t a chance that I’d get sign-out exactly at 6, so I’d work on another computer on starting my notes for the day.
7 a.m. – 8 a.m.
We’d use this time to round individually on our patients and start on our notes. On the peds floor, labs were only drawn 3 times a day to minimize the number of sticks (blood draws) our patients would get. If we needed to get labs at any other time in the day, we’d have to do it ourselves.
8 a.m. – 9 a.m.
We had either morning report (Mondays/Wednesdays), case conference (Tuesdays), grand rounds (Thursdays), or an intern lecture (Friday) during this hour!
9 a.m. – 12 p.m.
We’d use this time to round on our patients with the team as a group. As with the ICU, our team was pretty ginormous, with our attending, 2 senior residents, 3 interns, 1-2 sub-I’s, 2 3rd-year medical students, 1 pharmacy student, 1 advanced nurse practitioner, and 1 social work student. We’d have to warn our patient (+ their family) beforehand about the size of our team so they didn’t assume the worst and think that they had some kind of a terminal condition. ._.
We’d try to sneak away (when not discussing the patients we were following) to call consults somewhere in between and put in orders as necessary somewhere in between patients so that we could get things moving in a timely manner.
Somewhere between 12-3 p.m.
As above, somewhere in that time interval, we’d find a way to sneak to the cafeteria to grab food for lunch. It was generally super busy on the floor though, so we’d be scarfing down our meals in a couple minutes in front of our computers in the work room to get things done.
I had clinic on Thursday afternoons, so I’d have to finish my notes and try to get everything wrapped up with my patients before signing them out to the residents who’d be covering for me while I was gone. On one such Thursday, I was dealing with 2 discharges and one patient who was in intractable pain, all of which decided to happen starting at 11:30 (when I needed to leave at 12). Needless to say, something got lost in the mix.
More specifically, I forgot to write a note for one of my patients.
…Which isn’t the end of the world, but of course, the note I forgot to write was for the attending who’s infamous amongst pretty much everyone as the one attending that you do not want to annoy. He’s apparently sent med students home crying and has ripped interns to shreds (verbally) in the past. I was steeling myself for a potential slaughter the following morning, but miraculously, he just asked me if I’d written a note the previous day because I couldn’t find it, and when I confessed that I had neglected to and apologized, he just said, “That’s not cool,” and let it go.
We’d use this time to follow up on anything else pending on our patients, call consults, talk to family members, write notes, update the sign-out sheets, put in orders, start writing discharge summaries, call our patients’ pediatricians to update them on the situation, call their schools/school nurses, nutritionists, and whoever the hecks else was needed to follow up on them after they left the hospital or went to rehab. This is also the time where we’d get new patient admissions so we’d go get a history on them and formulate a plan/put in orders for them too.
Sign-out would start at 6 and was also on a first-come-first-serve basis, so I’d usually try to park myself in the resident room by 5 to start working on everything. We’d let each other go first depending on each other’s schedules though.
All in all, the people in pediatrics were really nice, but I did have some trouble in the beginning, mostly because I felt kindasorta thrown to the wolves in the sense that I never got any sort of an orientation and felt like I was just expected to know how everything worked despite never having been on the unit before (or on inpatient pediatrics in general). It improved with time, but I’m definitely not a fan of working 12 days straight for 12+ hours each day. I also felt somewhat isolated since I attended the peds lectures on Wednesday afternoons and barely ever saw anyone from my own program over the 4 weeks.
Weekends were the worst because we’d only have two interns to cover all the patients we had (~12-15 patients each, not counting all the weekend admissions). I wasn’t in the best of spirits (especially during the second week of each of these 12-day work weeks) and I thought I was doing horribly because I was too exhausted to do much of anything by the time I went home, but during one of the “Feedback Fridays,” my seniors told me that I was doing a great job and that they were impressed by my ability to “rise up to challenges,” so…hooray for that?
- Ever narrowly missed getting verbally slaughtered by someone after making a dumb mistake? I’m still so very grateful. Maybe he saw the terror in my eyes, hahaha.
- Have you ever gotten feedback that you were really surprised to hear?