One isn’t supposed to judge a book by it’s cover. Everyone knows that. Kids learn this saying in elementary school. But it’s just too easy to do so. In my opinion, this is because we humans are “lumpers.” That’s how we learn. We lump things that are similar into categories and when we encounter something new, we try to see which category it best fits into. Or perhaps I am a lumper and I am lumping you all into the same category as I am.

But back to books and their covers. I remember being on call while assigned to the Pediatrics service one night. As I pulled my vibrating pager off my hip and read the message, I learned that I would be going down to the Emergency Department (ED) to do an admission. There was a young girl who was presenting with what seemed to be an asthma exacerbation. I went into the resident call room, discussed what I needed to do with the senior resident on call, and headed down 6 floors to the ED. I chose the elevator, of course.

In the room, I saw the little girl. She was sitting on her bed playing with an older relative while a TV program ran in the background; well maybe I should say it ran in the foreground because it was pretty loud.

I turned to the child’s father. Since the child was in no apparent distress — she was, after all, playful and breathing well — I began taking the history from him. Her father, whom I will just refer to as “Dad” for brevity, remained in the chair, his eyes affixed to the television.

We talked. I asked. He answered. Our eyes rarely made contact. Most of the time Dad kept his head tilted upwards towards TV set. He didn’t even bother turning it down.

I felt like he was disconnected — like he didn’t really care or feel this was a big deal. I didn’t make this conclusion based on his continued TV watching alone. Other things felt odd. Details were sketchy. Some of my questions regarding the timeline of the girl’s asthma just didn’t make sense. I wondered to myself if he was actually very involved his child’s care. But I plugged on through the interview like a good 3rd year medical student.

At the end, because I had forgotten to do it earlier, I asked him if his daughter had any exposure to tobacco smoke at home. “Yes,” he answered.

“Who smokes,” I asked.

“Me,” came the reply. He only momentarily looked at me before averting his gaze.

I said alright and left it at that. I was eager to leave. I was tired of dealing with a parent who obviously didn’t appreciate the significance of being admitted into the hospital from the ED. Did I bother suggesting that his daughter should avoid 2nd hand smoke? Did I take time to suggest he quit? Did I offer help?

No. I left.

A couple days passed and I was sitting in the Physician’s Workroom with other students and residents working on our progress notes. Our attending came in and announced that she had talked to Dad about his smoking and he had expressed interest in quitting. One of us (the resident or I) would be in charge of getting Dad in touch with the tobacco cessation program people.

I was stunned. Dad wanted to quit?!? The same Dad that seemed more interested in the television show than his daughter’s admission?

It was something I should have caught. It was something I should have offered. But to me, he looked like he wouldn’t be interested. And that was my mistake.

“They” say never to judge a book by its cover. I’m inclined to say that this is one lesson I’m still trying to learn.

I apologized to a patient — for not being a woman. As I walked into the room, and the nervous laughter erupted from both her and her mother, I knew something was up.

“What brings you in today,” I asked after we exchanged the customary introductions.

“She’s shy,” her mother answered as the two of them laughed again. “She was hoping she would get a girl doctor.”

And with that, I drew some conclusions as to why they were in the clinic. The chief complaint, as listed in the chart, was a simple one liner: “abdominal pain.”

The girl — no, the young woman sitting on the exam table in front of me was probably as uncomfortable talking to me as I was talking to her. Because when you’re a brand new 3rd year, you learn pretty quickly that you will have to “fake it” more often than you’d like. You come into situations you have only ever read about. You have to talk to a patient about the most private parts of their lives. Then you have to offer counsel and, hopefully, a plan to fix whatever they came in to have fixed all without sounding like a clueless idiot fumbling with words and eye contact and all that social jazz.

At one point I was asked if the sporadic pain and the irregularity between menses is normal. I laughed and said I obviously didn’t have any firsthand knowledge about it, but I knew it was normal.

She said she had no other symptoms. But I asked if she had back pain and the answer was yes. I had her move around and palpated her stomach. There were no masses; it caused no pain. I reassured her that it was not appendicitis. It was just normal, young-woman, growing-up pains. She’s growing up.

And I think I am too.

[Show as slideshow]

Today was my first day at a new location. After one month doing Pediatrics inpatient, I have been sent to do Pediatrics Outpatient at a hospital in East LA. Picture 3 shows a view of downtown LA from the hospital.

On a number of occasions, my attending made reference to the fact that many kids to the west of here have those totally organic diets, but not “here.” East LA has a population that is of a lower socioeconomic background than the west side (this would include Beverly Hills, Santa Monica, Bel Air, etc…). So at least there is a perception that the patients I am seeing have a need to be seen — which is a plus for me, personally.

At Orientation I learned that I had been assigned to Pediatrics for my first two weeks before classes begin. Not quite sure what to expect, I followed the directions and found myself sitting in a conference room Monday morning with the rest of the Freshman who had been assigned to Pediatrics.

The group in the conference room also included third and fourth years who were on their Pediatrics rotations. After an orientation to how things were done in the Children’s Hospital, the Attending Physician took sent us off to find the teams we were assigned to. Some first years went to the cardiology consult team, others to the GI team, some to the NICU and others to the PICU.

I, along with one other first year, headed to the Pediatric Teaching Office (PTO). The PTO is located across the street from the Children’s Hospital.

I quickly found out that the PTO is a very relaxing place to rotate through. Over my one week there, most of my time was spent sitting in the office along with the residents.

When the residents did go in to visit patients I was able to go in with them and watch, hand out lolipops, smile, and ask the parents some questions regarding the development of their child. The residents/attendings were really nice about letting me listen to some sounds with my stethoscope. One of the interesting things I had a chance to listen to was a heart murmur that indicated that the patient had a ventricular septal defect.

In between patients, there was not much to do. I did not bring a textbook to study. I would have found it interesting to talk to the 3rd year medical students or even the residents and attendings. But I didn’t want to get in their way. Those not seeing patients were busy looking up things on the internet, reading an article, telling jokes, discussing wedding plans, and describing the latest exciting cases going on across the street in the main hospital.

As a first year it was at times very overwhelming because I had no idea what the acronyms and jargon meant. I couldn’t chime in on the discussions of exotic childhood diseases or advise on the appropriate vaccination for a 6 month old coming in for a “well child check-up.” I did, however, appreciate being able to watch a number of different doctor interacting with their patients. It is interesting to note the different styles — some bad, but mostly good. Those little things will definitely be something to pay attention to as I cultivate my own style in dealing and interacting with patients.

Part of me feels like I just want to get through these first two weeks of “Clinical Experience” and start lectures. At least I will have something to do. And I will know what to do — study. But I realize that once lectures start I will miss the PTO.