We began our little, week-long pediatrics rotation yesterday. This one was a little northwest of us, and wasn't too terribly difficult to find - as usual, Nicole and I drove out there the day before. The first kid we saw was a big ol' (not obese) 10 or 12 year old kid who screamed bloody murder when it came time for his PPD (tuberculin skin test). Those things do, hurt, but the only time I've seen that big of a reaction from a kid that old has been when there was some mental illness involved. The nurse had such a difficult time holding the kid down, that the doctor himself - an older gentleman who may very well play Santa Claus during the holiday - had to rush in and administer the shot himself. At this point, I silently glanced over at Nicole, as if to say "Nuh-uh. No way in hell. Not for me".
But the next little boy might have changed all that. He was about 3.5 years old - the middle of three kids. His older brother kind of hung around the room, while his little sister broke into whimpers every time the doc came near her. So this little boy had some adenoid cyst at the back of his skull that was of a great deal more concern to the parents - one of who had been this pediatrician's patient - than to the doctor himself. He'd come in because he'd been having a fever, but he was looking and feeling better. The doctor had us listen to his heart, and I was expecting some kind of atrial septal defect (the most common kind in kids). I listened to the four valves at the top of his little heart, and they were clear as a whistle - S1, S2, and silence, nothing else. I got down to his mitral and tricuspid valves, and could very clearly hear his first and second heart sounds - separated by a little early systolic murmur. The important thing is that this murmur went away when the pediatrician had the kid lay down - that meant that it was just an innocent murmur, and there was nothing more for the parents to worry about.
I think I was a little floored at how clear this little kid's heart was. See, we have the Harvey patient simulators, with tons of different problems and all the possible abnormal sounds a heart can make (just about). However, whenever I practice with Harvey, I find myself going in a little skeptical; I know that in real life, no one's heart is going to be that clear; real people don't have volume controls like that. But you know what? This little kid's heart was the clearest I've ever heard - so clear that I didn't have to think about it at all. I've never really considered pediatric cardiology, but there's something nice about most of your patients having bell-clear heart sounds.
The rest of the day was fairly uneventful; an osteopathic medical student from Nicole's neck-of-the-woods was scheduled with us, so we chatted about the injustices and hardships we all face as med students (not quite a pity-party...but close). We got to a little kid with asthma get put on a nebulizer that looked like a train, we talked with the doc about fevers and medications for kids, we saw a healthy-baby check on a one-month old - and actually got to see some of the reflexes we read about, but rarely ever get to see.
Finals are next week, and then 5th semester will have been but a dream.
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