No Champagne for Me!

This month I have been working in the pediatric ER. At first, I was a little apprehensive about doing peds ER, because I was afraid of seeing kids hurt or dead. The only time I ever came home crying from LDER when I worked there was when I helped try to revive a baby that was shaken and killed by her father. (We never revived her). I was worried that working in a Peds ER would be like that every day.
It turned out that this ER is not a trauma center, so any kids who are really hurt badly are taken somewhere else, which was a relief to me. Of the children I saw, I'd say 90% of them didn't need to be in an ER at all. Their parents would bring them in for little things like a cold, or vomiting one day--stuff my mother would never have dreamed of taking her children to the hospital for. Her philosophy was, "If it still bothers you in 3 days, we'll go to the hospital." And after this rotation, I would say that more parents need to adopt that philosophy.
The rotation turned out to be really good. I would pick up a chart, go in and interview the patient and parent(s), and then come out and let the doctor know what I had found out. At first, all of the doctors would return to the room with me and do their own interview to make sure I hadn't missed anything important, but by the end of the rotation, most of the doctors were taking my word for it and simply asking, "So, what do you want to do for this kid." I would list off the labs or x-rays or whatever, and the doctor would say, "Okay. Order it." That was that. I was in charge of the care of those patients. If I ordered blood labs, I could, if I wanted, do the IV and get the blood myself. It was my job to follow up on the labs and make sure the doctor saw them. If I ordered an x-ray or CT scan, it was my job to watch for the results and let the doctor know what the radiologist read. It was my job to follow the patients.
On the last day of my rotation, I was able to perform a lumbar puncture on a 5 week old child with a fever. Any kid under 6 weeks automatically gets an LP if their temperature is above 101.4. All month I'd watched the resident try to do this procedure--usually sticking the kids 2 or 3 times before giving up and asking an attending physician to do it. On this last day, the resident wasn't there, so I asked the attending if I could try the LP. He said I could, and he was there with me to talk me through it.
I was really nervous at first, but then I thought, "Dr. Z is right here. He's not going to let me do anything that would be dangerous for this child. I just need to listen and to trust him." He told me what to do, I did it, and with just one stick, I was collecting tubes of crystal-clear spinal fluid. It was really a great experience. Dr Z said, "Congratulations, you've just managed to do in your first try what our resident hasn't been able to do all month."
Dr Z also said it looked like it might be a "champagne tap." He explained that this meant if there were no red blood cells in the fluid, he would buy the person who did the stick (me, in this case) a bottle of champagne. I had done the tap at the very end of my shift that day, so I didn't get to see the results until I went back yesterday....1 red blood cell. No champagne for me. Still, it was a really great tap. Dr. K showed the results to the resident and said, "See? See how the RBCs are in single digits instead of double or triple digits? That's what it's supposed to look like." I felt kinda bad for the resident.
Anyway, it was a great rotation. Today I'm studying for the pediatric shelf exam. The only problem with doing my pediatric rotation in the ER is that I didn't learn a lot of the stuff that I would have learned if I was just in a Peds clinic. I didn't learn about immunization schedules and well-child checkups and developmental milestones, etc, so I'm learning that stuff today.

Cheers!