The nurses met me on my first day at the office, and the first thing they said is, "You got your walking shoes on, right? Dr. Mills is a fast one!" While I was waiting for Dr. Mills to arrive, I actually ran into Sam Sperlik, my classmate, who has been shadowing a different pediatrician for the past two weeks! I knew she had been with a pediatrician, but I didn't realize we would be at the same place.
Yesterday was a short day because we were supposed to do rounds at the hospital in the morning, but all of Dr. Mills' patients went home. He didn't have anybody he needed to go check on, so I didn't have to come in until 1:30 when his appointments started. Even in that short amount of time at the office, I learned a lot!
The first patient I saw had a strawberry hemangioma, which is a benign tumor formed by excess blood vessels, and it actually looked exactly like a strawberry on her arm. Dr. Mills told me that it doesn't hurt anything and is really just a birthmark that will eventually turn blue then back to normal within a few years.
Another patient I saw yesterday was having trouble with bronchitis and wheezing when she breathed. Dr. Mills let me listen to her breaths through the stethoscope, and I could clearly hear her wheeziness when she breathed out. He explained to me that sometimes the tubules in your lungs constrict, which causes the wheezing, much like a car window. When the window is slightly cracked open, the noise of the air blowing in is much louder than when the window is open wider. The nurse gave the girl a breathing treatment to open up the breathing tubules, then I listened to her breathing again after the treatment, and it sounded much better. Albuterol, the drug, is meant to relax the muscles around the tubules so that they can open more and lessen the wheezing, just like the car window.
An older patient came in who had a concussion a couple days previously and was still having headaches. Dr. Mills let me look in his ears, and in one ear I was actually able to see a blue ear tube, which is a tiny cylinder placed through the ear drum to allow air into the middle ear. The ear tube should have been in his inner ear but instead was in his outer ear because of the trauma of the concussion. Even in just two days, I have gotten to look into a lot of ears, and this morning I saw an example of an ear infection "as bad as it gets," as Dr. Mills said. First, I looked into her healthy ear, and it looked white, clean, and pearly, but then I looked into the other ear, and it was bright red and filled with pus. At least it was a good comparison for me to see!
Channel 11 actually came this morning, and they wanted to interview Dr. Mills for a story on the most common current illnesses, so he took a quick break in between appointments and was recorded on camera. Apparently, starting at five tomorrow morning, every half an hour they will choose a short clip of the interview to share on the news. Everyone was joking with him for being such a "bigwig" in town.
In the afternoon, I met a baby who has had a lot of complications, including a tracheostomy and a recent heart surgery. Dr. Mills had me listen to her heart, which instead of sounding like a normal, even beat, sounded like a gallop or series of three beats at a time. (Between the pediatric office and the NICU, I have gotten to listen to several different kinds of heart beats, including several heart murmurs in the NICU.) The baby had a big scar from the heart surgery, plus a bunch of little scars around it from several different chest tubes that were put in. Attached to her trach was an "artificial nose," which I learned moisturizes the air she breathes in like our nose does for us. If she didn't have that, she would just breathe in dry air, like if we breathed through our mouths all day long.
One of the last patients I saw, another baby, had a very yellow appearance, which is exactly the same as the jaundice I saw in the NICU. The whites of this baby's eyes were even yellow, which showed that the jaundice was fairly severe. Because a lot of the patients I have seen are babies, I have been able to connect quite of a bit of information I learned in the NICU to pediatrics. In fact, I wasn't expecting to see as many babies as I have in the past two days. At least half of the appointments I have been to were babies under the age of sixth months.
One big thing that I have noticed between the pediatric office and the NICU is that the NICU is much more hands-on because it is constant care, whereas the environment is much different when there are appointments all day. In the NICU, the nurses spend over 12 hours a day with the same patient, whereas pediatricians spend about ten minutes with each patient, and most of that time is spent diagnosing and prescribing drugs. One of the parents even said jokingly today, "So have you seen Dr. Mills give any vaccines yet?" It was a good point: in general doctors don't do as much of the hands-on jobs as the nurses. While I don't dislike pediatrics, I really like the constant hands-on work of the nurses (with the newborn babies!) in the NICU.
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