The Big Leagues

I was a big baseball player growing up. T-ball, coach pitch, Little League, American League, all the way up through high school ball. The developmental leagues in the American ball system have a very specific method to their madness. Each level has its own set of skills it develops. T-ball is all about learning the rules of the game and the fundamentals - how to field a ball, how to throw a ball, etc. Little League is all about proper technique, learning how to turn a double play, who to hit as your relay man, and such. By college ball/minor leagues, the fundamentals are all supposed to be in place, and you focus on refining technique and maximizing talent. Then you reach the big leagues and its all about delivering on your talent.

Academia is a similar sort of setup, especially when it comes to medicine. High school is your t-ball. Developing study skills, learning the fundamentals of each subject, starting on your critical reasoning. College is your little league. Experimenting how to efficiently learn, developing your reasoning and communication (and drinking) skills. The pre-clinical years of med school are the minors where you are working on adding the necessary information to your cranium to step up to the top level.

Lame analogy? Super lame. But the nickname around here for the clinical years is the "Big Leagues" and after a week of getting my feet wet I can see where it comes from. No more syllabus to hold your hand and feed your orange slices between innings. No more cute little "classic presentation" clinical vignettes to tell you to lower your elbow on your swing. Just you, the patient history, the physical exam, some lab tests, and a team of individuals grossly more experienced and knowledgeable than you waiting impatiently for your assessment and plan. It's terrifying but infinitely more fun.

Anyways, enough melodramatics. I think the rub is that third year is an entirely different beast. Peds has been a great rotation to start on. By its very nature it tends to accumulate more nurturing personalities and its been a good atmosphere to hopelessly stumble around in during the first few days. From the intern to the attending, everyone has been great at understanding and helping me with my incompetence. Kids are definitely my fave patient population and we've had some real cute ones on the floor this past week. I'm glad my first H&P was with a mother concerned about her adorable little daughter instead who was previously healthy and not on a 47 year old chronic patient with a PMHx and a Meds list the size of the US deficit. So I'm having a blast so far. Some moments from my first week:
--10 year old little boy who presented with focal hemiparesis. Was originally given diagnosis of acute disseminated encephalomyelitis, until the CSF came back with oligoclonal bands and tests showed myelin basic protein antibodies. Diagnosis of Multiple Sclerosis, that was a real heartbreaker.
--Little 2 month old baby admitted with poor feeding and failure to thrive. MRI showed diffuse hypomyelination of the CNS. In medicine, generally the more names in a condition, the worse it is. Especially if they're German names. This baby was suspected of having a condition consisting of 3 German names. Such a bummer, and the worst part was that he was perfectly healthy at delivery and until 8 weeks of life.
--On call when the intern gets a page that a patient admitted the night before for UTI was "turning blue." We run down to the room and see a poor child who was inconsolable in her mothers arms, had just had an impressive bout of diarrhea, and who had purple extremities with cap refill of 4-5 sec. Luckily everything turned out alright and she was discharged today.
--The family practice intern walked in on two cystic fibrosis patients doing the horizontal handshake. Yes, we all know the hospital is a boring place when you're a patient, especially when you're there 1/4 of the year, but probably not the best way to exchange nosocomial organisms.
--Poor 8 year old girl who presented with a history of 3 days of fever including a fever of 105.7! I can't even imagine how miserable she must have felt. Blood culture grew Streptococcus. Thanks to the miracles of medicine, her stuffed Tigger and she were discharged today.

That's it for now. I'm post-call and it's time for bed.