Thursday . August 15 . 2002 . 6:48pm |
grown-ups suck So that's it. Enough is enough. Tomorrow I'm switching from the Adult Infectious Disease Consult Service over to Peds ID. I hope it doesn't seem like I'm being fickle, or wussing out or anything like that, but it's just time for me to change. I want to go back to working with kids. The first, and more noble (sounding) of the two reasons is based on life preference. Back in the day, when I was still torn between adult and pediatric medicine, I asked one of the more sage, senior attendings how it was that I was going to decide between the two. And what she basically said was this. Do electives in both fields. Give yourself a chance to decide. And if perchance you're doing an elective in adult medicine but you find yourself continuously thinking, "I wonder how they would approach this problem in Peds? I wonder how this might be different in a pediatric patient?" then you'll know that Peds is for you. I told you she was sage, because that's exactly what's been happening to me this month. Even though I had already decided on Peds, I purposely chose to do Adult ID, because I saw it as one of my last chances to work with adult patients. I figured ID was the most generalizable of the medical fields between adults and children (as opposed to, say, cardiology or GI, where the problems you deal with are vastly different by age; heart attacks versus congenital malformations, colon cancer versus duodenal atresia, you get the picture), so it was a good choice for my hurrah with the Big People. And after wrapping up the adult portion of this rotation, I realize that this is indeed to be my last time working with adults. Ever. But now for a slightly different reason. Adults are gross. Especially from an infectious disease point of view. Face it, all you adults out there, YOU ARE GROSS. First, in adults ID, you have to deal with all the diabetics and people with peripheral vascular disease. All your amputees with stump infectious and non-healing ulcers and fungus growing in assorted crevices. And then you have your geriatric patients, the sad, little old ladies (and men, but more ladies, since they live longer) who have no teeth and can't talk and just make little sad moaning sounds all day, transferred to the hospital from a nursing home for spiking fevers, which are mysterious and without obvious source until someone gets the bright idea to turn the patient over and you see that they have some gigantic bedsore on their butt, so deep that you can see through to the bone, and basically soaking in their own urine and poo. Aha. And then you have the random homeless man brought in off the street, confused and shouting, for whom the ER docs call an ID consult on the off chance that he might have encephalitis, but with a more likely diagnosis of alcohol withdrawal. And did I mention that this patient has giant, long, curling toenails, with a small forest of dirt, moss, and fungus growing underneath each ample underside? Yeah, so like I said, grownups are gross. Obviously I am over-generalizing and being completely negativistic (remember, there was a point that I wanted to do adult medicine too, so obviously I don't think it's all bad), but after a month on Peds, you get used to doing things a certain way, or having a certain type of patient, and it's just my personal viewpoint that even when kids have gross things wrong with them...it's still not that gross. Kids have diapers, they poop on themselves, but you expect that. They have infections too, and can grow fungus dehisce their wounds and grow bacteria in their brains and all the rest, but...I can't explain why, it's just somehow less nasty than in adults. And kids aren't ravaged by the destructive forces of old age. They have parents who, for the most part, clean them and love them and watch out for them. And that makes Peds nicer. Most of the time. (Maybe it's just that I need to have patients that I know I can overpower. And then I'll kick sand on them and take their candy. The true motivations come out at last.) In any event, I'm back in the children's hospital tomorrow morning. xo Michelle |
