My Patients are Cuter than Yours!!

Posted by Jenna at Sunday, October 02, 2011

To say that I LOVE my third rotation (& preceptor!) would be the understatement of the year! I started my Pediatric Surgery rotation with Dr. Allison Blackmer on Monday. I was a little nervous for 2 reasons:

• She knows that I'm interested in peds so I thought she was going to be extra hard on me because of this.
• This is her first year precepting @ UofM so I had the idea that she was going to be super hardcore.

Well neither of these were reasons to be nervous because neither ended up being true. Since Allison knows that I want to practice in peds and knew that this was my only peds rotation, she is making sure that I'm getting everything out of it that I want to. Now, obviously, there are certain pediatric topics that we need to cover and only 4 weeks to explore my huge interest in peds but I really appreciate her willingness and desire to tailor this rotation to my interests. (This isn't just because of my interest in peds, she tries to tailor her rotation to what her students want to learn, see, & experience). I feel like she is a demanding (in a good way) preceptor but she realizes the fine balance of pushing you to the max while also knowing when to let up a little. 

Rounds happen twice a day, working rounds from 5:45-7:30 (the senior fellow then goes into the OR for the remainder of the day) and teaching rounds from 9-12. Because rounds start so early, the expectation is that I just get in about 10-15 minutes before rounds start. For clinical rotations you would usually pre-round for 1-2 hours prior to rounds, depending on how long it takes you to look up labs, med changes, overnight events, etc before rounds. I typically get in at 5-5:15 so that I can look up a few things before rounds, which start in the NICU and then move up to the PICU! I've never shadowed in the NICU at Mott before so this was exciting to me.

The pediatric surgery service is made up of an attending, a junior & senior fellow (only 1 of them rounds), 2 fellows, 1-2 PA's, 1 med student (M3 or M4), 1 dietician, 1 social worker, and 1 pharmacist. They have a very specific order in which the information on rounds is presented so the first few days, it felt like I was just hearing a bunch of random numbers. They definitely rely on Allison for a lot and she has clearly built a great relationship with the team in the year that she's been here. There are 2 teams within the service, the floor team and the critical care team. Unfortunately, they both round at the same time, so Allison attends the critical care rounds and then follows up with the floor team to see what they need. When I first started the rotation, I didn't realize that I was going to be going on rounds and following the patients in the NICU, PICU, & PICU II (aka 'the deuce,' or moderate care), so I was pretty excited when I learned that. I've spent a fair amount of time in the PICU and so I'm happy to be back, although the NICU may be my new favorite. :-)

The first day of rotation, Allison handed me a pager. I'm not gonna lie, I was actually kind of excited (yes, excited) .. it made me feel like a real healthcare professional! This past week she used it as a means of communicating with me.  But on Friday, I actually asked if we could give my pager number to the team starting tomorrow. Maybe that's crazy and maybe I'll regret it but I wanted to have the full experience of being asked questions, having to look them up/analyze the literature, running it by Allison, and then getting back to the team with my recommendation. So tomorrow is the day .. the day that my pager will start beeping nonstop all day like everyone else's does at the hospital. I'll keep you updated on that experience!

I've seen some interesting things already, including an abdominal washout and a trach change. I've watched the abdominal washout twice now, which allowed me to see an open abdomen. I find that having a smaller, or average sized team is nice because the members know each other quite well. The babies and kids are absolutely adorable, which can sometimes makes it hard to pay attention! Some of the infants and toddlers are exceptionally cute and so it's hard for me not to stare at them or make silly faces to make them smile or laugh and then I end up missing things that are being said on rounds. Oops! Darn kids and their cuteness!

Outside of rounding, we also have a topic discussion daily about some of the common surgical issues seen on her service, such as gastroschisis, short bowel syndrome, PNALD (parenteral nutrition associated liver disease), etc. Preparing for topic discussions and making a handout everyday gets to be a lot but it's stuff that I enjoy learning about. I'll also have 2 journal clubs and various other activities, including attending the MSPEN (Michigan Society of Parenteral & Enteral Nutrition) meeting with Allison. 

So far, my days have averaged out to be about 12 hour days. Honestly though, I really don't mind. I am loving the rotation, the patients, the learning, and the preceptor so the 12 hours doesn't seem so bad. Life's about doing what you love .. well, if I needed further clarification, this is it. I love peds. I come home with a smile on my face every day and look forward to going in in the morning, even if it means waking up at 4am and getting 4-5 hours of sleep a night; it's worth it in every way.