more on the wards...

This will be a short post- its another day on the wards...
We saw several patients on rounds but left early to hear med student presentations on Hemolytic Anemia and Thallassemias. Then we returned for a "Journal Club" on urine testing and went to micro pathology to see examples of nephrotic syndromes on slides from the past month.
On the wards we saw a baby- born at 32 wks, hospitalized for a month, home for three days, returned with aspiration; intubated twice.... etc...etc.. The one thing of note was that with this baby they had pushed epi peripherally and there was terrible gangrene necrosis at the site. Yikes. It was awful looking and just lying there on the large child's bed. They noted that these parents had not paid for any care yet, and their grace period was over. They will probably have to let this baby die very soon. There is a set period during which the hospital will cover costs for unstable cases after which point most patients receive limited care.

A second child surprised the physicians by yelling at them after they called him "Judi"- his mother's printed name on the sign "Judi's baby." He yelled "Kevin!!" and pointed to himself. It was explained that lately alot of parents have been surfing the internet for western names and they have seen in clinic all the kings of England and several Lincolns. Kevin seems an unlikely aberration.

They use cisapride regularly on infants (although not on adults). Alot of American neonatologists wish they could since its off the market due to adult arrhythmias.

The SSPE case is still baffling everyone. The diagnosis was made at an oustide facility which had a CT no contrast (looks normal). What do you think? 9 yr old male, handwriting deteriorates, peripheral atrophy and tremor- mostly fingers, arms- like intention tremor but severe. Occasional spastic abdominal muscles, legs weak, atrophic. Inability to walk without someone to fall on, feed self, use restroom. Cognitively intact. Tongue fasciculations, strange cogwheel-like rigidity. Normal reflexes. Ok, so that wasn't in any presentable order, and its what I observed of his exam, but any thoughts? I guess I could read up online....
that's crazy talk.

I do not want to offend anyone- this is an honest observation- but I have found much of the academic discussions curious in comparison to our US discussions. For example, "Journal Club" featured not an article about new research or a comparison study of urinary testing tactics, but rather an article just generally explaining what urinary testing was, the diseases associated with leukocyte esterase etc...
The resident presented a very general article- I don't know how to say this- but it was MSIII level. The powerpoint explained everything you could test in urine and what diseases are associated with casts etc etc.
In all the presentations we've seen and discussions we've witnessed, none have had "evidence-based medicine-" no mention of articles demonstrating effective or ineffective treatment or testing.
Everything is referenced from Nelson's- it was not Journal Club as we know it.
The medical student's presentations were required to be on the chalkboard- no powepoint- because they might "paste and copy." They were pretty simple= they are only second years! which makes them college sophomores!

The way in which the attendings motivate the residents to think about disease is also different. I find myself frustrated not to hear the thought process moving in the fashion I have come to find predictable. But it is a subtlety of the training. It is admirable how much time is spent asking the radiologist and pathologists questions.

Oh, we also saw a renal biopsy. Very little of the room was sterilized- about as much as for an I&D. The child was given versed but still cried and cried from fright. They used a biopsy gun- small and had ultrasound guidance prior to starting. I took pictures. No gowns, sandals fo sho.

That's all for now! We are trying to decide if we have the time to go to Ooty this weekend or should hang out here. Love to everyone at home. We are all very much missing Mexican food.