This week I began foray into the land of runny noses, worried parents, and whaling children, otherwise known as the pediatric ward. Above all else, I’d like to take this opportunity to express my new found admiration and respect to every single person who at one point or another was, has been, or currently is, the parent of a small child. Seriously, one week down on the general pediatrics service and I am exhausted to the point of delirium.
I guess it had never quite occurred to me that pediatrics encompasses everything from newborns to adolescents – a full 17 and some years and countless developmental stages therein. With this wide spectrum of ages comes a whole spectrum of physical exam maneuvers and differential diagnoses, because children of different ages get sick with different diseases, and may even present differently even when they do have the same ailment. For example, say in a given day, you see a 10 month-old, a 2 year-old and a 17 year-old, all in the hospital for a cough that sounds productive (i.e. they’re coughing up mucus). Although, taken at surface value, the chief complaint is the same, there is very little chance that they are all suffering from the same disease process.
All this makes the field incredibly challenging. The vast breadth of information that a pediatrician has to master is impressive to say the least. And what is more, they have to do it all, often being unable to ask the patient questions – after all, a child younger than 5 probably isn’t completely aware of what’s going on with their body when they’re sick, and most of the time won’t know how to answer questions about their illness.
A pediatrician acts as a detective, a cryptologist, and an interpreter, all in one. They have a variety of physical exam tricks in their arsenal, specific for age and ability level, using the results as clues as to what is going on with the child, deciphering body language and other non-verbal cues at the same time. Most importantly, they have the keen ability to relate to parents, and ease their fears and concerns, such that they’re able to provide a thorough history and strengthen the other findings as to the etiology of the disease. All in all, it’s a monumental task, which demands remarkable skill and the patience of a saint, what with screaming, flailing, and projectile body fluids thrown into the mix.
Admittedly, sometimes on the floor it feels like a zoo. But at the same time, it’s refreshing to see the resilience of children when faced with adversity, something I think we can all learn a lesson from. For instance, a young child who felt crummy on Thursday, by Friday, will have forgotten the trial of the day before, and will play as if nothing had ever happened. That innocence that allows them to truly live in the moment is beautiful, especially in a field like medicine, where often those moments are limited. So far it has been inspiring to walk in the shoes of a pediatrician, and get a glimpse of the long-forgotten joy for life that we all had as young children.