25 July 2012

The day I made a kid cry

"You're such a terrible doctor, I can't believe you made my son cry.  If I had known you were going to make him cry, I never would have let you look at him."

Yes, I whispered something mean into your 6-month-old's ear to make him cry.  

You've been in our clinic 4 times in the past week because your kid has fever.  Only he never ACTUALLY shows up with fever.  Even though he hasn't had any tylenol in the past 12 hours.

And you're mad at ME for trying to help your kid?!

I have to check him and figure out where the "fever" is coming from.  And yeah, checking his urine just might hurt him a little bit. But not checking it and missing a urinary tract infection would sure hurt him A LOT more. 

Some people just don't get it.


Wednesday I walked into work and my Medical Assistant said "Oh, Shannon, you look different!"

"Good different or bad different?"

"Just different."


I guess I’ll just go with it.


I've decided I need to stop reading.

Whenever I was in school and I would read about one of the various diseases I was studying, it would suddenly appear in clinic the next day. I would recognize all the classic signs and symptoms, because I had just reviewed them in my book.  Then I would look brilliant in front of the doctor I was working with, win some brownie points, and learn even more.

I thought that would end as soon as graduation happened.

I don't have anyone to impress anymore, so why do I need to look smart?

But Monday I did some continuing medical education on Mononucleosis, more commonly known as Mono, the kissing disease.  I work in pediatrics, so its bound to happen to one of my patients at some point.

Problem is, it's super hard to differentiate from just a normal sore throat.  And you have to run a pretty expensive test to look for it. And you treat it mostly the same, only you have to be sure to tell kids with Mono that they can't play sports in case they are at risk to rupture their spleen.

I came away with the knowledge of how to differentiate them and what exact test to order: an IgM and not an IgG test.

The next day at work I had a girl come back with a super sore throat,which pain medication didn't really help at all.  She still had a high fever and her tonsils were HUGE and had lots of exudates.  I thought she would have strep throat, but the test was negative, so I diagnosed her with a viral sore throat and she came back the next day because it was still SO painful.

I got Dr. Velez because I was worried that her tonsils were so big that they were touching in the back and I was concerned about how she would eat and breathe.

He told me to test for Mono and he pulled up pictures on google saying that usually Mono gives kids bigger tonsils, with lots and lots of exudates.


I just learned about Mono, only to miss it in one of my patients.

He told me to order a Mono test, and I was able to pick the IgM test, because I had just read about it.

It turns out, the test was negative.  No Mono.

So I wasn't wrong!  

This time at least.

But I better stop reading...because the other day I learned about a disease called HMP: Human Monkey Pox.

I'd hate for a kid to get that...


So one day, I had a kid who came in from the WIC (the Women, Infants, andChildren program) office with "Iron poisoning."


Only she didn't eat extra iron.  She doesn't take iron supplements, and neither does her mom.  She didn't ingest a nail.

In fact, she was completely asymptomatic.  She didn't have pallor, fatigue, tachycardia, abdominal pain, or vomiting, which I only know to expect from iron poisoning because I looked it up just before I saw her...

Clearly, I'm still learning.

So, I did what I always do when I get a kid from the WIC office with anabnormal lab value, I repeated the lab.  I wanted to have it documented. And because half the time they're wrong.

Turns out this kid just has high hemoglobin in her blood.  Which WIC interpreted as Iron Poisoning and scared mom half to death.


A normal hemoglobin is usually between 10.5 and 12.5 in kids. 

This girl had 19.

Or 19.7.

We had to run her blood 4 times because the machine wouldn't read it as a normal blood because her hemoglobin was so high.  (But don't worry, we only had to take her blood once)

So, I was stuck.

What to do now?

Ask someone else! 

 So, I asked Lucia, who's been working at the clinic more that 5 years, she's pretty brilliant.  But she didn't know.  And told me to ask Dr.V.  Who was at work, but had his door closed, meaning he didn't want to be disturbed.

But this is the kind of thing I have a supervising physician for.  If he wasn't at the clinic I would call him.  So I knocked on his door and he told me to come in.

I asked him what to do and he told me:

"I don't know, call the children's hospital's (CMC's) Hemotology (a fancy word for blood) team."


I always feel better about asking him something when he tells me that he doesn't know.  Because he's a genius, and if the genius doesn't know, it's probably ok if I don't know either.

So, as I'm waiting for the attending physician to pick up the phone, I glanced through this kid's chart to look at her past values for her hemoglobin.

Surely this is a new thing.

Or surely not.

All 2 lab values we have for her were also in the 19s.  


The attending physician at CMC for Hemotology, was an awesome Dr. named Dr. Buchanan who talked to me and genuinely cared about my patient.  He told me it could be just a normal artifact for an extra protein she has in herblood, or it could be a weird childhood cancer.


So, we set up an appointment for my kiddo.  


As if my day couldn’t get any better, the mom who told me I was a terrible doctor came back.

And she said she didn't want to see me.  But she ended up in my room anyway.

Because no one else wanted to deal with her.


So I called in Dr. V for reinforcement.

He told the mom everything I said, and told her not to worry.

Good.  Hopefully she stops coming in for fever when her child doesn't actually have one.

Did she keep the temperature log when I asked her?


She did know that only over 100.4 was an actual fever when Dr. V asked her.

I guess I taught her something.



Some days I save lives.

Not every day.  Most days I just fix runny noses.

But this one 14 year old came in for a well child check up.

Along with his 3 other brothers and sisters who were pretty young.  So he went last, letting the others go first.  Polite.

Or he was just a chicken.

When I listened to his heart and thought I heard a murmur.

So I casually asked mom about it, the way I do when I’m pretty sure there’s a murmur there, but not positive.

Mom was surprised,“No one has EVER heard a murmur before!”

And she got that terrified look of a mom who has no idea what’s wrong with her sweet baby.  (the same kind of face I think anyone would get if they had some doctor that looks like a child tell them that something serious is wrong with their kid)

I told her not to be alarmed, sometimes I just hear things that aren’t really there, I would get another doctor to listen.

And if it wasn’t a murmur, that’s fine, I make mistakes,
But if it is a murmur, he has had no serious symptoms, so he should be just fine, he’ll just need a checkup with a heart doctor.

So I grabbed a more experienced doctor, and sure enough, he has a murmur.

That is NEW at 14 years old.

So, I sent him to a cardiologist, and reassured mom about a million times. 

I felt just like a superhero!

Especially because I had some cute Spiderman nail polish on :)

Then other times I don’tfeel like a superhero at all.

We had a kid come in that should have honestly probably been taken to the ER, but he was at our office, struggling to breathe.

I momentarily freaked out, he was wheezing so loud, I didn’t need a stethoscope.



I sent one Medical Assistant (MA) to get a machine to check his oxygen level and the other one to set up a breathing reatment.

Then I grabbed my supervising physician.

Who immediately sent another MA to get a Dexa shot.

Which is short for dexamethasone, which is a steroid shot that we give for super bad asthma kids when they’re having an acute attack.

He told me to look up how much to give.

Um, so his weight in kilograms is about 16.  Um, how manymilligrams per kilogram is Dexa?  60?

No. it’s 0.6

I was so close.  Just off by 100 times…

So the kid needs about 10 milligrams of dexamethasone.

Man, I’m slow.

And the worst part isthat they blamed my MAs for being the slow ones.  I apologized for that. 

I guess the super hero nail polish doesn’t always work…


Thanks to the new stickers that are on my books, printed in English and Spanish, less of my books have walked away!

But man, kids still find a way to destroy some of them and the moms don’t even care at all!  Disgusting.

One mom was great though.

She asked me if I hadkids.

Because who owns board books when they don’t have kids??

This girl right here.

Maybe that’s why people trust me even though they think I’m only 15.  Clearly, if I have books in my room, then I must have raised good kids that can read.

And therefore, I can be trusted.

That, and the fact that I’m SUPER white, but I can speak decent Spanish now.

Enough Spanish to geta few complements several times a week.




No wonder I’m such a great Physician Assistant…


Sometimes I need to put things into perspective for myself.

I get frustrated that so many of my parents walk in with iPhones with their nails done up so fancy, yet they need government assistance to buy their kid’s food.

I need to give grace, because no culture is perfect, even people who work really hard need help sometimes.

A lot of my kids come in wearing hand-me-down clothes.

A lot of my kids don’t have their own phones.

A lot of my kids are in day-care so both their parents can work.

A lot of my kids come to the park right outside my apartment because it has a huge fountain that is free, instead of going to a water park. (I know this because my Medical Assistant knows where I live now, because she can see my high-rise apartment complex from the park where she and her friends bring their kids to play in the fountain.)

A lot of my parents are really trying hard to give their kids a good life, and they need help from the government to do that.  Because two people working a minimum wage job can’t raise a 6 person-family without help.

And a lot of my parents have dealt with so much tragedy: gang killings of their eldest kids, kids that get into drugs and die from overdoses, girls that become mommies at the young age of 15 and 16.

Yes, their kids get free healthcare and medicine, but no, that doesn’t make their life easy.

I just have to remindmyself that.

We’re all given grace.

I need to extend it to everyone around me.

Even the people who let their kids shriek in the park fountain by my house till midnight and then don’t pick up their trash….


Ryan and I have been disagreeing.

There’s a road welive by that’s called Cesar Chavez.

I think it’s pronounced CAEsar, with an AE, and Ryan thinks it’s just CEsar, with an E.

I asked my Medical Assistant, since I’m clearly not yet an expert on pronouncing Hispanic names.

She told me it usually depends on how it is spelt.

Mmmm.  Maybe Ryan wins again.

I really gotta find a book to help me pronounce these Hispanic names.

Although, thankfully, there are some names that I don’t need help pronouncing.

Take “SirCharming,”for example.  His mom replaced the name Charming with another equally as great name.

Poor.  Kid.

Hopefully he has agood middle name he can go by.


Removing the soda stains on the roof of my car.  A can of 7 up exploded.  How was I supposed to know it would turn brown?  I now have a new respect for anyone who paints ceilings. 

The pup curled up in my blanket :)  he loves mommy!

My superhero nail polish!

Sushi cooking class!

Some yummy rolls!

Ryan always made better looking rolls!


Our first try at home!  It went pretty well!

1 comment:

  1. Man, you just get more amazing every moment! You rock!
    I do have bad news, it's pronounced Seyzar (like "grey", not like Caesar from Shakespeare... and history). My dad gets that day off because it's now a county holiday apparently (Caesar Chavez Day) and he sends my mom flowers for fun on that day. Chavez was a grape picker who led a pseudo-revolution, so my dad's card always says "Happy Grape Picker Day!" - finding fun in the mundane I guess?