Pediatric Dilemma

Babies and small children are not miniature adults, and taking care of them is far from child’s play. After the machismo world of surgery, my pediatric rotation would introduce me to a much kinder and gentler group of physicians. It was just a coincidence that the head of the pediatric department was not much bigger than your average 14 year old, but a great deal wiser. He was an expert on the treatment of cystic fibrosis, that serious genetically transmitted disease causing patients to develop tenacious, thick respiratory secretions leading to recurrent lung infections, and at the time of my training, early death. His wife, also a pediatrician, along with the rest of his staff, worked very hard to ensure that students rotating through the service had an excellent learning experience. While asking questions to demonstrate the optimal thinking process in arriving at the diagnosis of a child’s problem, they never demeaned you or made insulting remarks about your lack of knowledge. Theirs was an entirely different culture than the one on the surgical service, and one in which I thrived.

I enjoyed being given the time to read about each of our patient’s ailments, and learned quickly how to best examine a sick child who was afraid, didn’t want to be touched, or was too young to give a meaningful history. I learned all this by watching the magic way the faculty had of dealing with each of these kids. I was also impressed with the incredible bravery exhibited by some of our patients in dealing with chronic and sometime fatal diseases. The dedication of both the nurses and the doctors in wanting to help their charges as well as the families made me decide that this would be a good specialty for me.

I spent the summer between my junior and senior year of medical school doing an elective pediatric rotation with Dr. Behrman, who at the time was head of Pediatrics at the University of Illinois in Chicago. He was involved in basic science research studying trans-placental blood flow using radioisotope labelled glass beads. He was using baboons for the research. Part of my duties was the transport of the pregnant baboons from the vivarium to the operative suite, then assisting him with the surgery involved in placement of the necessary catheters. I apparently impressed him enough with my already acquired pediatric knowledge at Tulane as well as my surgical assistance skills that he offered me a spot in the internship class at Columbia (where he was moving to become the new chief) after I graduated medical school. Dr. Behrman was clearly a rising star in his field, and the prospect of continued work with him was more than I had hoped for. I returned to New Orleans for my senior year buoyed by the knowledge that I not only knew what I wanted to do during the rest of my medical career, but I had already secured access to one of the most coveted programs in the country.

The Greeks have a saying that a man’s plans cause the gods to laugh. Tulane offered a month elective rotation called Community Medicine. The concept was to allow students to spend a month with a physician in private practice in the area of their chosen interest. Not only did the students spend all day with their mentor, but lived at their house, attending both their medical and social extracurricular activities. Since I already had chosen pediatrics for my specialty, at the start of my senior year, I naturally chose a pediatrician as my mentor. All students should be given this opportunity, for the time I spent on this rotation totally changed my perspective on what it means to be a pediatrician. Until then, the only experience I had involved hospital based patients; never office practice. This limited exposure gave me the idea that pediatrics was a hospital based specialty, when nothing could be farther from reality.

During the month, I found the average pediatrician spends 99% of his time in the office doing well baby care and seeing children for routine follow up, making sure that they were reaching their developmental milestones at the appropriate times. The rare times they saw children who were sick enough to require hospitalization, they frequently ended up turning those very sick children to the care of subspecialists, like pediatric hematologists/oncologists. While rewarding in its own way, this was not what I imagined wanting for myself. Working in his office with mostly middle to upper income mothers, I also discovered that the most educated and rational women in his practice could become total raving lunatics when it came to their children, convinced that their child’s minor ailments were the signs of impending disasters. This meant half of his practice consisted of his becoming a psychiatrist to deal with their irrational fears, rather than just treating the kids. I knew I definitely didn’t have the necessary patience (which he showed in abundance) and I best rapidly rethink my choice of specialty.

Most internship/residency slots are assigned based on the National Match where each applicant lists all programs where they applied in order of preference, and the programs list all the applicants in the same fashion. This way, applicants are then matched with their highest choice, assuming the programs ranked them equally high. My problem was that the deadline for the match was only two months away, and most programs required a personal interview. My first and hardest task was informing Dr. Behrman that I had decided not to pursue pediatrics, and would not be availing myself of the slot he so generously offered me. He did not take my rejection well, as he had given me considerable amount of his time during the summer, and took my rejection as being personal as well as professional.

My next problem was what type of residency to apply for, and I chose internal medicine. I felt medicine was a broad enough field to offer something that I could enjoy, and would provide a useful base even if I chose to make a change in the future. I thus applied to all the New Orleans based programs where I already knew people, and could have local interviews. I also applied to LA County-USC, as being one of the two largest programs in the country, where a personal interview was not required. I had never been to Los Angeles or the West Coast, but I called and spoke with a couple of Tulane alumni from the class ahead of mine who were training there. They assured me that the program was very good, and they loved living in LA. Now, the die was cast.

More to follow…

This entry was posted in America, Health and wellness, Medicine, School, The South, Thoughts & Musings, Uncategorized and tagged , , , . Bookmark the permalink.

1 Response to Pediatric Dilemma

  1. timfergudon says:

    This blog resonated with me in special ways and on different emotional levels. Though our medical school experiences were in different countries and different cultures & languages, the challenges, the desires, the uncertainties were remarkably similar. Yet I can’t help but feel that through it all God’s fingerprints and His Will was at every turn forging our paths!! Tim

    Sent from my iPhone

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