Rotating Through the Pediatric Emergency Room: Part II

While Drew and I are deep in conversation, suddenly someone says, “Whoa, these labs,” and I make a beeline for an open computer.

The results are back for our child with the rash: red blood cell count normal, no elevation in white blood cell count, electrolytes normal, coagulation factors okay, everything looks great… but…zero platelets? Not normal. This patient has idiopathic thrombocytopenic purpura, also known as ITP. (ITP is a platelet disorder where blood doesn’t clot properly due to a low platelet count.)

I’ve been told that most emergency physicians have “first time” cases: cases saved on a mental hard drive that they will always remember. There’s usually a slot for the first time they suspected and caught ITP. This time, we caught it. Next time, I’ll know to suspect it.

I ask our attending if I can break the news. She says no, we have to call heme/onc (hematology/oncology) first to finalize the plan. I ask if I can call. Her eyebrows shoot up, but she hands me the phone because she remembers what it was like to be a bright-eyed, bushy-tailed medical student trying to learn medicine. Nic walks in and asks what’s happening just as a gravelly voice from the receiver, the heme/onc attending, demands to know why I’m phoning this late at night. I get the dosage of steroids from the heme/onc attending and hang up.

I turn to Nic and realize I had dropped communication with him to go straight to calling the consult. “We called hematology/oncology, and they’re going to admit him,” my ED attending informs him.

My imposter syndrome resurfaces with a vengeance. I had taken responsibility and moved care along for the patient but in doing so had gone ahead without getting consensus on the decision, a potentially fatal flaw in some situations because I don’t know what I don’t know. I was a medical student playing doctor under the protection of my attending’s license and the guidance of my resident. Who did I think I was, insisting on calling consults?

I wait for his response as the moment stretches infinitely, mattering more than it should under the heightened stress of the ED. I nearly start to apologize, when Nic stretches his neck.

“Great. Want to go see a 19-day-old?” he asks. I shut my mouth and stand a little straighter.

“Yes,” I reply as I whip out my piece of paper, scribbling “check vaccination status” on top.

My brain feels alive, zapped into action by encouragement. Nic’s a good teacher, the kind that pushes you to stand on your own, think on your own, catches you when you stumble, and lets you go. It makes me want to be better than I am.

“Room 33,” he says, and we move.

I write notes, present, and doctor. Children cry. Alarms blare. Computers continue to malfunction. Food comes and I wolf down fries that are not mine, convince x-ray to squeeze in one last patient before a shift change, and watch as the team treats a girl from a car crash. Could I be managing this girl’s spiral fracture in a year? Maybe.

I ask our attending and Nic to fill out a written evaluation form, something required after each shift to complete the rotation. Informally, Nic asks how I felt like the night went. The question catches me off guard, and I ramble something self-deprecating, instantly wanting to take it back, because what I really want to say is: thank you.

Thank you for letting me fly, for teaching me, for being patient, and for being kind. I learned things I won’t forget because you gave me the chance to learn them. I felt both supported and challenged and I wish my heart had a chance to catch up with my brain so that I could have expressed some of my happiness and appreciation in real-time.

Then I blink and it’s midnight. Cinderella should leave before the magic wears off, but I’m reluctant, because I’m both wired and tired, and did I finish that last note, and is that patient still tachycardic?

Drew tells me to leave in no uncertain terms (strict duty hours policy for the safety of patients, staff, and medical students like me). I grab my bag and finally haul home to bed.

Tomorrow, I will process all of this. And the day after tomorrow, I’ll be back here, chirping my usual greeting, meeting residents who will inevitably leave an impact, and intersecting with a world of patients for the briefest moments in time.

Part of me hopes that this will one day feel routine, but the other half – the half that still cries when the music swells at the end of the movie – hopes it never will.