Young and pregnant

On my schedule today was "new OB". I really like OB patients- partnering with someone for 9 months, mostly healthy and happy. As I was getting ready to enter the room I glanced at her age - and did a double take- 14.   14 years old?! 8th grader? C'mon.

There was no mistake, in the room sat a very young girl, hair in braids, up in these pig tale things. A couple earrings in each ear, tight jeans and trendy shoes. The other woman in the room was grandmother.  "where's your mom?" I asked.  "she's actually here in the hospital, she just delivered a baby last night- a new brother"  Oh great! I'm sure her mom was thrilled to learn as she went into labor 2 nights ago, that her eldest, her 14 year old, was also pregnant.

I kicked grandma out the door to talk one on one with my patient. Believe it or not, although she has a boyfriend, age 15, they had only slept together one time. "only takes once" is the sound bite that began to play in my head, not needing to state the obvious, we moved on to planning.

I often have people ask - what's the youngest you've seen pregnant.  I know our clinic has seen a 13 year old, whose mother was actually 26 (history repeats itself). And an Ob/Gyn doc I worked with had a 9 year old deliver a baby... unfortunately the 9 year old had been abused. And just today working in peds- a girl who got pregnant at age 10 just delivered this week- her boyfriend is 13 and it was consensual, and they plan to raise the baby. The correct answer: it gets younger every year.

At 14 the scope of my concerns were remembering to wear the right uniform for home basket ball games, deciding whether to get chocolate chip cookies or a nutter butter bar at lunch for dessert, attempting to say a nervous hello to my latest crush, and trying to sell more candy than my best friend while fundraising for mission trips. Real similar worries to raising a child...

A different path

We've been excited to watch our neighbors (let's call them rick and sue) to the left go through their first pregnancy.  We share a lot in common- both finishing our basements together, watching each other's dogs, and the husband is even attending the medical school I went to. Last weekend the wife went into labor. We waited each day to see the new baby come home and wish our congratulations...it seemed strange that we hadn't heard any news.

Finally, last night I ran into rick on my way in.  "hey, what's the news?"  "Well last friday we had a little boy - 7 lbs 4 ounces... "oh yeah, congrats!" I interjected. Rick continued, "yes, and, well, it looks like he's got down's syndrome" I paused, shocked. What next to say? What was coming out of my mouth was I'm so sorry - but that didn't sound right...I shouldn't be apologizing for his son's life! But it was still something unexpected.  We talked for quite some time about the experience - 

The most heartbreaking element was the experience they had with their doctor.  After the delivery, rick was looking at their newborn son and could tell something didn't look right.  The Obstetrician finished his work, glanced at the baby and just jetted from the delivery room without saying anything.  Next the nurses left, handing the clearly unusual looking baby back to the parents, not saying anything.

Abandoned now, the silence of the unknown must have been unreal. Both rick and sue were left with their private thoughts, minds whirling at the unthinkable.  Finally rick spoke - "are you thinking what I'm thinking."  They called the nurses back in demanding information.  The obstetrician never did come back in the rest of the day to talk. 

We plan and dream out our details for the future- but really we never know what lies ahead. Their son is by no means a tragedy - it's just a shock.  The blessings his little life will bring are not ones we spend time dreaming about, but will occur none-the-less

21st birthday tragedy

After a long day of clinic yesterday, I had the privilege of working a 7p-7a ER shift.  It was a typical ER night, with strep throats, urinary infections, and drug withdrawals inter spliced with the more serious cases.

One case was especially tragic. The ambulance brought in a guy who had been out celebrating his 21st birthday drinking. What seemed like a mild problem-  having too much alcohol led to a cascade of events.  He must have gone outside the bar, passed out in the 3-4 degree winter night. He likely had thrown up multiple times, and breathed in the vomit, over and over again - too drunk to know better.  So there they found him - laying in his vomit, not breathing, and cold enough to die.  I first saw him as they rushed him into the ER, already with a tube down his throat to breath.  He was not responsive, and almost blue from the cold.  Will he make it? Unsure.  His lungs are full of the vomit, which causes multiple problems... how long had he not been getting oxygen to his brain? another problem.  Damage to his heart? His kidneys? unknown.

The shock his parents must have gone thru, as we called at 2 am to let them know their son, on his 21st birthday was on the brink of death and in our ER.

Neurotic parents

Perhaps my first clue that something was amiss was the complaint the nurse wrote on the chart of "fever, cough, and skin smells like urine".  I walked into a room with 2 parents and 2 boys-  a 3yr old and 16 month old, standing and writing on the chalkboard that is in every pediatric room.  The boys seemed active and by no means really ill.

"So, what's going on with these guys" I asked after introductions.  Mom then handed me 6 handwritten pages of information.  2 pages were filled with the fevers of each child, labeled with the time, the initial for which kid and what they were doing. IE: "c. 101.2, 3:15pm, twitch in right arm and left toe while sleeping"  I'm sure my eyes were as wide as saucers as I glanced thru to the next pages - giving a recent history of the illness each child had from January on - ear aches, antibiotic courses, diarrhea and spit ups.  OKAY, then 2 pages of questions and concerns mom had - including the double underlined "Skin smells like urine". 

"Wow, really organized" I said as I looked again at these crazy people masquerading as parents. I really hardly ever have the problem of too much info, but this was definitely the case- My head was swirling with fevers, twitches, spit ups and urine smells.  What was really wrong anyway? 

As I examined the kids, I found out more disturbing facts - that they both had been diagnosed with unnamed eating allergies- the 3 year old allergic to most foods, including milk (isn't this called being picky in the toddler years?) They were seeing a GI specialist, an endocrine specialist, and a  feeding specialist already, with no clear diagnosis yet.

I tried really hard to find a urine smell- with my nose planted on his arms, his legs, his stomach - praying one of my colleagues wouldn't come in to find me sniffing a little kid. Sure the boys had a cold, like everyone else this time of year- some fevers, some cough - but nothing else.

I left a little afraid for those boys - perfectly healthy, normal boys whose parents are trying so hard to find something wrong with them. All those specialists, not even needed. Unfortunately, it's the parents who need the help!

Grave plots

The discussion today around our Sunday lunch glossed briefly over a mildly disturbing topic.  In a very business like manner I heard how some of the family's grave plots are switching hands.  My parents buying 2 slots from an uncle. The uncle in turn getting 2 places in another state near his parents' grave. This advantageous purchase will allow my parents to be buried next to my grandparents...who, I may add, are currently alive and well, and participating in the grave swap transactions.

Grave plots.  This one wasn't mentioned in personal finance classes in high school. When is the right time to buy a sight? Should I be out hunting for plots now? Is the point to get generations all lined up side by side, or to be laid to rest in the place you live most of your days?  If that's the case, then it's too early to tell where I'll want to be...if buried at all. 

I suppose as creatures who have a hard time believing our lives on earth are finite, discussing grave sights is low on the list. But you may want to find out just what your family's plan is, so you won't be left without any earth to call home. As for the reminder at lunch that life does come to an end, that our dried out bones and leathered skin will need a place to rest, it should be an impetus not for fear of the future, but to love more with the time we have.

Bobby Pin

This month I'm working in pediatrics when not in my clinic.  Besides the typical time of year things like - strep, colds, stomach flu, ear infections - we occasionally do get to see some interesting things.  This came in yesterday.  Use your radiologist expertise to find the abnormality:


Hint:  14 year old girl standing in the bathroom at school, fixing her hair -  She has the bobby pin, used to keep the bangs out of her face, in her mouth. She reaches to her mouth to open the pin first, the other hand holding the stray hair in place. Suddenly the bobby pin snaps out of her hand, and shoots -  down her throat.   There you see it, sitting in her stomach.  Lucky for her, the bobby pin had plastic protective heads.  The specialist in GI matters that came to look at this film decided to just let her pass it.  Hope it comes out okay -

Burn Hazard

There are certain hazards people forgot to warn me about in medicine. I was kindly taking off some anal warts of a 20 something patient in clinic today.  I was using a type of acid solution...which I informed him wouldn't hurt too bad.  In this process, I suddenly had a searing, burning sensation on my leg and realized a portion of this acid had dripped onto my nice pants, thru to my leg, and quite the contrary to my previous reassurances, it DID burn!  I could not just leave him in his awkward half exposed state to take care of my burn, so continued the treatment despite the pain.  When I later went to the restroom to clean up and look at the damage, I was reminded of the uncanny coincidence of another medical burn on this same spot acquired exactly a year ago. That old burn, that left a slight scar, was after a 36 hour shift on call in the hospital.  Not acid, but a piping hot- wait,  let's call it what it was, a boiling cup of hot chocolate poured onto my scrubs before going off call.

No one warned that besides blood products crammed with viruses, cough droplets filled with bacteria and other unpleasant bodily fluids, that as a medical professional I could be harmed by acid and hot chocolate - But now I've got the scars to prove it!

Success

We all measure the success of our days in different ways.  I wonder how aware we are of those unspoken measurements we place on ourselves?  It's different depending on what we do, or what we are after.  In pursuit of someone's affection, our success may be if we spoke to that person during the day.  If there is some behavior we are trying to change, our success may easily be, did we have that forbidden food or smoke that cigarette we swore we wouldn't?  If in school, did we actually get the work done on time?  Everyday, thousands of chances to give ourselves value by "succeeding" or devalue ourselves by "failing". 

It's good to find what we use as a ruler - because it may be completely unreasonable and need changing!  If for instance I made "success" pleasing every person I saw in the day, I'd be a big 'ol failure.  I was thinking of this today because I identified one of those subconscious measurements I've set for myself.  I realized that when I have my own clinic, with my own patients, I gauge my performance on how many times I had to ask a preceptor/staff doctor for input.  If I am autonomous, I give myself esteem.   However, asking another doctor's opinion shouldn't be deemed a failure- in fact, it's probably healthy to ask others for input.  Looks like this is one measurement of success that needs tweaking.