Residency 2.12: Blue Team

Well, I made it through another year. Go me. My final month of 2nd year was spent with the same kids I first took care of as an intern on inpatient--heart kids and cystic fibrosis. It's amazing how much I've learned in between. I remember my very first overnight call on Blue Team, not letting my senior out of my sight, asking whether it was okay to redose lasix if a kid puked. Last night, on my last overnight call of Blue Team, I basically just laid down and let my fabulous intern handle everything. Maybe all I've learned is how to delegate. Just kidding, I've been doing that for years, right, Mom? Okay, but seriously, it was somewhere in between pushing adenosine on rounds before sending the kid to the PICU and getting every question right on Cardiology Jeopardy that I was able to sit back and go, huh, turns out I know something after all.

Specialty services are funny, because the inner general pediatrician in all of us gets to shine a little bit. When one of our heart babies spiked a fever, the recommendation of the attending cardiologist was to "consider evaluation for otitis media." Resident to the rescue! We didn't even have to call ENT. Another one of the cardiologists admitted to having palpitations when we asked him to come look at a rash. Once again, we saved the day (diagnosis: miliaria crystallina).

Of course, these kids have much bigger problems than ear infections and heat rashes. And even though you know the outlook for heart disease is bad, it doesn't make it any easier to come in one morning and find a kid that you talked to yesterday is brain dead. And it's rather depressing watching teenagers with cystic fibrosis sit around waiting for a lung transplant because they have lost most of their ability to breathe. Thankfully, there were some silver linings. One beautiful boy with Down Syndrome suffered several strokes after his heart surgery, and when he came out of the PICU we weren't sure he would recover any function. He would lay in bed and stare at you, occasionally moving his right hand. But after several days of set-backs, lots of therapy, and optimizing his heart and lung function, we came in on the morning of discharge to see a new boy. He was sitting up in bed, circling his finger near his ear, the universal sign for "You're crazy" with a huge grin on his face. When we came in with the whole team wearing party hats to celebrate him going home, we got an enthusiastic double thumbs up.

This month I had an exceptionally amazing team that worked together like a well-oiled machine, if well-oiled machines could laugh until they cried. Still, I wasn't sad at all to pass off the baton this morning to three brand-spanking-new interns with wide-eyes and shaking hands. I ended check-out with a horror story of a single-ventricle patient who came in overnight with cardiac tamponade, SVT, and laryngomalacia who needed pericardiocentesis, adenosine, and chest compressions, all on the floor since the PICU was full. "And you better run up and check on him right away to make sure the fluid hasn't reaccumulated." The look of relief on their faces when I told them I made the whole thing up was priceless.

Tomorrow I start my Urgent Care elective. Hopefully a nice break away from the hospital that will perhaps help narrow down career choices. But mostly I'm excited to only be working 16 days this month. Hasta!