Nightmare on Elmo Street
Facing the dreaded peds clinicThe New Physician
I was unsure of what to expect on the first day of Student Continuity Practice (SCP), a program at my medical school that places students into local clinics one afternoon a week from the beginning of the first year all the way through the third. It is a way the University of Connecticut School of Medicine gets students to really practice medicine—not just shadow a physician—and to follow patients long term.
I was initially dismayed to learn I’d been assigned to a pediatrician, Dr. Neil Stein, in West Hartford. The first thing I thought of was how much I disliked pediatrics. If only I had opted for internal medicine or family medicine instead! I did not realize just how much I preferred working with adults until I was told that I had to work with children. That Stein occasionally saw adults with congenital issues did not assuage my apprehension. In my mind’s eye, those three years of SCP stretched into an eternity of torture. I even tried to get reassigned, but the program director was having none of it. I wondered if I would make it out intact or scarred for life.
Walking into the good doctor’s office on my first day, I pushed that thought to the back of my mind, determined to make the experience useful, if not enjoyable. Suddenly, I wished I had fortified myself with a few bars of chocolate before arriving. My clammy hands did not bode well for the afternoon ahead.
Stein, as it turned out, was just my kind of doctor: relaxed, approachable and knowledgeable without that condescending, arrogant air that infects some doctors like a bad case of head lice. I appreciated his warmth and humor, and his readiness to say “I don’t know” in the same breath as a promise to investigate. Maybe this whole peds thing was not so bad, after all.
But wait! Were those really children I saw in the waiting room—those little hobbits in midget-sized outfits reminiscent of Britney Spears? Who knew they made them that small? Ditto for the kids.
Our first patient was a screamer in all his 10-month-old glory. I could barely hear above the din. It was a wonder Stein was able to conduct himself in a professional manner while simultaneously carrying on a civilized conversation with the boy’s mother. There was no sense in me trying to hold the baby still—he had the strength of an elephant. I tried to focus on the arrangements for the boy’s care while sweat bullets sprung from my temples. Yet Stein ignored his antics as he gave the flu shot, then spoke with the mother about asthma medications.
I walked out of the consulting room both enlightened and terrified of the future. Images of countless irritable, noisy toddlers swarmed in my head, and I took a moment to steady myself by the doorway. To my credit, I had a ready smile for the doctor and a quick “Great!” when he asked how things were going so far. What a skilled liar I was becoming.
That day, we saw patients ranging in age from the 10-month-old to a 40-ish man with spina bifida, a congenital condition in which the neural tube fails to close properly during fetal development. I did not even notice when the 6:30 p.m. closing time came around, or that I had not sat down for a second since arriving at the clinic.
I was fascinated by all I had seen and learned that day. Stein had spent the few minutes he could grab between patients filling me in on their histories, answering my questions and discussing everything from Big Pharm to federal health guidelines.
The biggest surprise for me was just how many American children are diagnosed with asthma. All but two of our patients that day had the disease. I also learned that it is hereditary—I had always thought it had everything to do with environment. What an eye-opener. One of the children we’d seen had asthma in her entire family: sister, baby brother and parents. A 6-year-old boy had lost his father to the disease last year, and his was already serious.
I liked Stein’s way of practicing. He always had fun with the kids, but was not so playful that he diluted the import of what he had to do. Think Patch Adams without the clown outfit, and on a lot less sugar. He seemed to do many extra things that I do not remember other pediatricians—even mine—doing. For instance, when examining a patient’s genitals, he would always pause before starting and explain to the child that the only reason it was OK was because the parent was in the room, and that if anyone else ever looked at or touched the child in the same way, he or she should always tell the parents, even if the person told them it was a secret. I found that a powerful testament to the ways he goes beyond the textbook and guidelines to care for his patients in every way, not just physically.
Now that I’ve completed my SCP assignment, I still know for sure that I do not want to enter pediatrics. But I enjoyed the opportunity to learn from this special population. Did I wish I were seeing adult patients? Every day. Did I force myself to stifle a blood-curdling scream every time I saw yet another ear infection? You betcha. Would I have liked to ask my patient a question directly instead of his/her mother? Of course! At some point I would have liked to take a CC, HPI, PH, FH and SH of someone who could actually control a bowel movement in my presence and knew more than two colors.
But I am proud to say that in retrospect, my initial apprehension, nervousness, lack of interest and aloofness regarding the pediatric population have gradually given way to curiosity, interest, knowledge and—dare I say it—enjoyment. I still prefer to work primarily with adults, but at least I have opened myself to the great possibilities that pediatric patients present.
Today, I am still amazed when something I learned at SCP comes up in class, or when I see a patient with manifestations of a disease we discussed in class and I have the opportunity to find out how it has personally affected him or her. Those “aha!” moments truly cement my commitment to medicine.
N. Abimbola Sunmonu is a second-year in the University of Connecticut School of Medicine’s M.D.-Ph.D. program.