Clerkship Day 21: Course in the Pedia Wards

Assalamu Alaykum! (Peace be upon you!)

August 31. One month after our first clerkship rotation in Pediatrics. What had happened so far and what have I learned? Perhaps a lot more than I expected. Certainly more than those bio-medico-socio shiz they taught us in the lecture rooms for three years (which most of them I already forgot by the way). All I can say perhaps is "Indeed, clerkship is a different level of academic learning." It drains not just your intellectual being, but more of your emotional and physical energy. 

Exhausting. That is the single word that can describe clerkship. At least on this first rotation. They say Pediatrics, as one of the Big Fours in PGH (together with IM, Surgery and OB) is one of the hardest and exhausting rotations. And guess what? We just survived it! Alhamdulillah!

I wasn't able to update this blog during my stay in the wards, mostly due to the limited time I have to focus on writing sensible post. A lot of things happened the past 3 weeks and most of them were too heavy for me to talk about. For now lemme share what I learned during my 2 week stay in Ward 11.

Admission: Welcome to Ward 11

As I may have mentioned in the past posts, during clerkship in Pediatrics, the whole block of clerks (16 students) rotating in this department will be divided into 3 groups: wards (8 students), PER (4) and NICU (4). My group already finished our turn in PER and NICU durign the first two weeks and so our last two was spent in the wards. The 8 students will then be assigned to 2 different wards: Ward 9  and Ward 11, both under the department of Pediatrics. 

Ward 9 composed of GenPed 1 (mostly cardio patients), GenPed 2 (GI) and Hema-Onco while Ward 11 has GenPed 3 (Renal) and GenPed 4 (Pulmo, Endo, etc) and Neuro. But as I observed during my stay in Ward 11, this is not always as strict as it sounds. We  have a new Hema-Onco service right at the Ward 11 wing, so H-O rotators are staying with Ward 11 as well. We also have cardio patients (GenPed1) with concomitant pulmo problems (GenPed 4), and so there are always some overlaps in terms of service doing the patient care. As confusing as it may seem, one will have to try to get used to it one way or the other.

I was assigned to Ward 11, GenPed 4 and most of my patients are Pulmo patients. I was assigned with a total of 6 patients during my 2 weeks stay as an SIC (Student in Charge).

 SIC (Student in Charge)

As a Pedia clerk, we were assigned with a number of patients that we will take charge of. We will be their Students in Charge (SIC) and as such, we are responsible for everything that our Resident in Charge (RIC)'s orders--RICs are Pediatricians from the same service. Being a Pedia clerk is simply like being an intern: you all do almost the same jobs as SICs. Of course being in the "higher rank" among the group, they are the ones who usually guide us when we needed help especially on our first few days doing SIC works. 

So what are SIC works anyway? It comes in different tasks or to-dos. As an SIC, you are responsible in making sure that all the orders that your RIC have in the charts are being done (by you of course!). You get the necessary diagnostics, you follow-up the results, you make sure your patients are getting what they need. You are also assigned to report new results, your new findings to your RICs. And when a patient is "endorsable", you are also the one to report/endorse the case to the POD (Pediatrician on Duty). Seems too heavy a task right? Don't worry, on your first few days, your interns and RICs will help you out during those hard times (especially endorsements).

A great tip from an intern: Really get to know your patients. As an SIC, the first thing you need to do is get to know your patients upon receiving their case. Read their charts, understand the history and current impressions (diagnoses) they have, if you are up to it, study their condition/disease. Meet the patient and his/her guardian, introduce yourself on the first day, build rapport and if you can, get as much necessary information you would need that are not written in the charts. Visit them everyday, ask about their course, make them feel you are there to help. If you have good relations with your patients and their parents, things will go the easier way. You will find this very helpful during your stay in the wards.

During my 2 weeks stay in Ward 11, I had a total of 6 patients. The first 2 were both toxic ingestion cases, both of them were intubated (connected to mechanical ventilators). After 3-5 days, Alhamdulillah, their conditions became better and soon enough they were discharged :) The rest of my patients are either PCAP, PTB patients, and one was a chronic HepB patient.(Don't worry, we are extra areful in handling communicable diseases)

Anyway, on my last day I only have 3 patients left. The other 3 were discharged in good condition. No mortality under my care, Alhamdulillah. (although I had a number of pretty horrible experiences in the ward during my duty days (-_-) 

Charting and other paperworks

Aside from ordering laboratory tests, SICs are also allowed to write incoming and out-going entries on patient charts. Awesome isn't it! You are now doing what real doctors are doing ^_^ just like a legit MD. 

Well, honestly, at first it feels cool... but then after doing a lot of paperworks, you will soon find yourself spending too much time writing on charts and other paper-works that you already consider it exhausting! Nevertheless, as doctors working hard to treat our patients, these are just a few little tasks that must be done.

Among those papers that a clerk must learn to fill up are: referral forms, discharge summary, clinical abstracts, the endorsement sheet (aka FRICHMON) etc. Ask your interns about this, they are always more than willing to help.

Losing patients :(

Perhaps among the most painful lessons I had in the wards is summarized in this statement by a duty-mate:
" When a patient enters Ward 11 (or 9), he or she has only two ways to get out: as a discharged patient or as a mortality."
Indeed I found these statement so true. Every now and then, we would lose a number of patients. And this place where life and death is in a constant battle, one can not simply escape from the depressing atmosphere that drains your energy in and out. Urggh sorry, I think I cannot talk about these things for now -_- perhaps on another occasion in sha Allah.

s/p Clerkship in Pediatrics

After that one exhausting month in Pediatrics, I have learned a lot of things which I never expected during my first few years in Medschool. I had this realization on how seriously hard this path I have chosen. It was never a joke in the first place. After losing a number of patients, it woke me up to this grave realization that hey, this is our patients' lives at stake! How could you be so irresponsible!

 Uggh sorry. My mind is still on a meshwork of mess.

For now, Alhamdulillah, we are done with our first one-month rotation in Pediatrics. Our next stop is Family medicine. And as an farewell remark to Pediatrics, allow me to ask for your prayers that may all our patients in PGH be given more strength to fight and be healed and become strong one day. Ameen!

Salam Kasilasa!
-Ahmad ibn Hajiri


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