Getting to know me, Real Medicine

Why I Paed

il_fullxfull.1060268322_b3xh_1b44cb32-38e5-43f0-83cd-e66691807124_grandeWhenever I talk about my love for child health, and my intention to pursue it as a career, I get this kind of response:

“Oh, I could never work with kids. It just breaks my heart to see them suffer!”

I don’t get it.

I mean, maybe I’m a cold-hearted bitch, but I don’t think so.

I hold children down and stick them with needles, because I know it’s necessary to make them better. I scrub burn wounds and I encourage parents to wait outside because I know they’ll cry and/or likely try to assault me for hurting their babies.

I also use topical anaesthetic cream liberally and question IV lines when I don’t think it is absolutely necessary. I’m liberal with analgesia prescriptions because pain is more harmful than useful in a hospital setting.

I see malnourished and abused children, and sometimes I bite my tongue raw to keep my temper.

I’ve told mothers that their children had cancer, and I’ve told them that their kids would be developmentally delayed for the rest of their lives. I’ve told them that their kids will live, but that they will be long-term patients.

(Thankfully rarely) I’ve informed parents that their baby was no longer alive.

* * * 

But I give more high-fives than I give pain.

I get gummy smiles and snotty laughter and the wide-based gait of children waddling around my legs.

I call in the social workers and the dieticians and we (try to) address systems, not just lapses in judgment.

I get to pick up a crying infant and feel it relax, because although human contact isn’t medicine, sometimes it’s just what you need in that moment. Both of you.

I get to discharge more patients than I ever have to declare demised.

When I tell a parent that their child is disabled, I get to tell them about disabled people who don’t only live, but THRIVE.

I get to admit a shocked child, and see her running around the ward two days later.

I get to witness the purity of the human spirit first-hand.

I tread among the future.

Paediatrics is the great success-story of 20th century medicine, and I rarely cry for it.

* * * 

Adult medicine? Oh I couldn’t. I’d cry all day.

Real Medicine

Working in the Land of Milk and Honey

By some kind of dumb luck, I am doing my Community Service posting at an incredible children’s hospital in Cape Town, rather than the archetypal middle-of-nowhere clinic post we all expect for ComServe.

And it’s incredible.

#lucky to work with this view; less lucky to be #oncall Friday and Sunday. #weekend #capetown

A post shared by Megz (@barefootmeds) on

This hospital is just something else. It’s public, but has so much private funding that it might as well be a private hospital. It gets a lot of private patients so clearly I’m not alone in my perception.

Some things that continue to blow my mind:

1. Pain management team

Absolutely essential, of course, but not something we had access to in the Eastern Cape. As part of pain management, our kiddies have access to aromatherapy and music therapy. How cool is that?!

2. Psycho-social services

When adults bring kids to hospital and they have witnessed violent events, the adults get debriefing practically before the kid even leaves the emergency unit. When a kid gets hit by a stray bullet, he gets trauma debriefing. There are support groups for kids with any number of conditions. All of these things should be a given, should’t they? But again, it’s something I’ve never seen.

3. Palliative Care Team

Last year, I often had to decide on my own whether a patient was for active resuscitation or not. It was a horrible responsibility, but not that I’ve learned just how much is involved within the practice of palliative care, I realise how WRONG it is for a clinician to have to make such decisions without an entire palliative care team.

My entire view of palliation has changed.

4. Gorgeous Operating Theaters

There are theaters with views of Table Mountain, and I just… wow. (The on-call room also has a view of the mountain.)

5. Clinicians who love their jobs

I can’t begin to tell you how amazing it is to be surrounded by senior doctors who are still passionate about their work. It gives me hope.

 * * *

One thing that is not available in the land of milk and honey is small-size theater scrubs. I still have to use a whole host of improvisations to prevent my pants from falling down when I scrub in for theater.

Oh well.

Real Medicine

Does It Have To End?

c4e635ecb89b5ed4844f087dca6580b1My four-month stint on the paediatric service comes to an end this week.

I enjoyed paediatrics in medical school, but never as much as this. How wonderful it was to be excited about work, to enjoy it so much that I willingly and eagerly read up more about all my cases.

It may have been one of the most challenging rotations – and it was good to see myself growing in confidence and ability.

There is so much work to do in paediatric healthcare, especially because you inadvertently treat the caregivers as well. And women are another group so sorely neglected in our environment.  Continue reading “Does It Have To End?”

Getting to know me, Real Medicine

Paediatrics: How Do I Love Thee

I noticed that four out of my last five posts here were sad posts. With good reason too: some scary things have happened.

But guys: I’ve had a fantastic two months. I’m on a four-month paediatric service and it makes me so… happy?

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Continue reading “Paediatrics: How Do I Love Thee”

Real Medicine

Baby-CPR: Full Circle

The first time I partook in a baby’s resuscitation was during my fourth year of medical school. It was a disaster: the wall-suction malfunctioned, the nursing staff were in the precarious business of changing shifts, and all algorithms flew out of the window.

I vowed optimistically that when I was a doctor, I would not let a baby die that way.

I had a lot of criticisms, which is so easy for a student to do; but I did learn from it. I learned to prepare myself mentally for any scenario where a life may need to be saved, so that I could give that life a fighting chance.

Last night it was my turn. I was called to the ward for a desaturating baby with pneumocystis carinii pneumonia (PCP). It was my call to start bag-mask ventilation, and then to start compressions when his heart rate dropped below 60.

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Chest X-ray of a child with PCP. European Respiratory Journal. Click for link.

Continue reading “Baby-CPR: Full Circle”

Bookishness, Real Medicine, Studying Medicine

What If Everything You Knew About Breastfeeding Was Wrong?

24612267How does one react to seeing a book cover that claims breast feeding is “big business and bad policy”?

If you’re me, you request a review copy of that book, fully intending to expose how wrong it is.

As a medical student, one of the important things I was taught again and again is this: BREAST IS BEST. We were given a nearly 100-page document to study about infant feeding during second year. We were expected to know the constituents of human milk and be able to compare it to cow’s milk and formula. We had to memorise tables of the various formulas on offer and their indications. In fourth year, an entire oral OSCE station was dedicated to breastfeeding.

Breast was best and formula-feeding was undesirable, and it all made perfect sense to me; and of course I never read up the literature because our professors had surely done that FOR us. Continue reading “What If Everything You Knew About Breastfeeding Was Wrong?”