Wednesday, August 16, 2006

A Doc's Life - More Memorable Moments (P.S. 7)

Scenario: Pediatric Surgery Department of a large local hospital

This was where I did a 6-month rotation. This is where I:

• found out I was pregnant with my first son; had hyperemesis gravidarum due to aforementioned pregnancy, resulting in my having to run out during ward rounds to throw up, asking the nurse to jab me with IM Dramamine during one of my calls, and almost throwing up on a patient when I was assisting the on-call consultant in a laparotomy. The sight & smell of gas-filled loops of ischemic, necrotic intestines which popped eagerly out of the neonate’s abdominal cavity was not a pleasant one, pregnant or not;

• saw my first (& only) omphalocele;

• learnt how to do laser circumcision. And I am proud to say that my handiwork was pretty good too. Thing about using lasers is that you have to have good hand-eye-foot co-ordination. Hand because you have to target the laser, eye because you have to see what you are doing (duh) & foot because that’s how you turn the laser beam on & off (or shoot the laser, as a layman would say). There was a fellow from another Asian country who wasn’t terribly good with his hands, & one time, when I was assisting him, I saw him inadvertently “shoot” the laser at the glans penis – he didn’t lift his foot off fast enough. My eyes widened in horror & I cringed in empathy (although I am female, I could still imagine how sensitive that area is). Fortunately, it was a very small, very superficial burn.

• was taught how to differentiate between abdominal guarding & voluntary rigidity (in babies & children, who tend to be more sensitive to being palpated, this can be quite hard to do).

• developed a phobia of calling up radiologists on call to help confirm & manage intussusception. For some reason, certain radiologists were terribly unfriendly, and seemed to do the barium enemas very grudgingly. I often wished I could have told them: hey, I don’t like waking you up in the middle of the night either, but this kid is in pain, & signs point to a likely diagnosis of intussusception, you know!

• learnt that projectile vomiting in babies with pyloric stenosis is REALLY projectile, if you know what I mean;

• realized that many “head injury” patients tended to be admitted at night. I think the parents had no time to worry until after dinner, when fearsome thoughts & scenarios start flashing through their heads about the bump on their DDC’s* heads although the bump may have been sustained a week ago.

*DDC = Dear Darling Children


igakunogakusei said...

So what do you do to differentiate guarding from voluntary rigidity, apart from distracting the kid?

aliendoc said...

Hard to describe :)

It's how you palpate the abdomen, & what you feel when you palpate it. The "firmness" is different...