08 February 2009
Everyone Has a Story to Tell
I know that I haven't written in a while. Despite my best efforts, I caught the "Pedi Flu." Pronounced Pee-dee, as in pee-dee-atric medicine. So, I have been snuffling and coughing along with my patients. I finally started feeling better this weekend, just in time to start my new rotation tomorrow... the Pediatric ICU. I've heard a lot of things from my colleagues, not a lot of which are positive, so we'll have to see.
I thought I would take the time tonight to wrap up this last month by talking about some of my more interesting cases. Interesting in this aspect - in college I was a journalism major because I found people's lives fascinating, and I wanted to write about them. I get to learn a tiny bit about my patients in the 5 minutes I have to interview and examine my patients. Sometimes I am just left to wonder what their home life must be like... or maybe I don't want to know... still...
Dx: CO exposure
So, we've had a flurry of these as the weather temps dip, and people start burning stuff in their fireplaces or wood-burning stoves to keep warm. Also, kerosene generators and space heaters can add to the problem. I had a mom come in with her three boys. She said the boys had been getting sick off and on over the last 2 weeks. The day before she thought she had smelled gas. She didn't know who to call, and that morning, she called her mother who told her to call the gas company.
When the gas company man arrived, he found two gas leaks. He told her to call her landlord and then get herself and the kids to the E.D. to be evaluated. While I examined her children, she told me about all the phone calls she had made to her landlord, and how she was still trying to get him to fix the leaky ceiling and clogged toilets. I turned and asked her about flushing the toilets, and she said that you had to use the plunger every time and that they were usually backing up.
Now she didn't know how long it was going to be before he would get the gas fixed. I put the two smaller kids on oxygen and wondered if I was going to have to do a social admit for the kids. After I came back in an hour and rechecked their levels, I asked her about her kids' safety and where they were going to be spending the night, she assured me that she would be going to her mother's until the gas could be fixed. She also said she had recently qualified for Section 8 and would be able to get another apartment.
I found the kids knitted hats that had been donated to the E.D. I counseled the mother about stopping smoking. (Smoking will elevate your CO level.) And, I sent them off into the night.
Dx: acute stress reaction
A mom brings her 5 year old son who has been acting strange, hearing voices, acting out in school, and falling behind because the school sent home a note. In the course of my interview and the subsequent psych interview, we learn that the mother had her mother and a sister die in a violent manner in Philadelphia.
The mom had a cousin who lived in Buffalo and was planning on getting married. She asked the mom to be in her wedding, and the mom felt the need to get away. So mom moves to Buffalo with her cousin and brings her two young sons. Five year old son misses dad and cries on the phone every night when he's talking to him.
So cousin gets into a fight with her fiance, and in the course of "needing my space" she kicks the mom and the kids out. So, mom goes to live in a homeless shelter with her two boys and ends up there for about 6 weeks. Somehow, mom manages to get Section 8 which helps her to find a new apartment, but locks her into a lease. Mom can't break the lease or she loses a lot of money. She can't get back to Philadelphia. And, now her five year old is hearing voices.
When I talk to him and ask about his friends in school, he tells me that no one wants to be friends with him. When I ask him if the voice in his head is an imaginary friend, he tells me that who would want to be friends with him. That's about the time that I felt a CT scan wasn't going to do this kid as much help as a psych consult would. Psych was able to hook the mom up with social services who would see about assisting her in getting out of her lease and moving back to Philly. That will ultimately be the cure this young boy will be needing.
Well, it's bedtime for me. I'll be rounding on a new set of patients in the ICU in the morning, and I am sure that there will be many more stories to share. Until then...