The Blair E. Batson Children’s Hospital has an inscription in the entryway which reads “Children are a message that we send to a time that we will not see.” I liked to read it every morning when I went into the hospital on my Pediatrics rotation. What will the world be like when the kids I saw each day are my age? I saw a lot of kids who didn’t seem to have much potential for messages of hope. Every week at UMC, dozens of infants are born. Too many of them come into the world with two strikes against them before they get our of the newborn nursery. There are crack babies, fetal alcohol syndrome babies, and HIV positive babies. I saw a two-week-old admitted for a femur fracture. She had “fallen” off of her father’s chest while napping, and he “caught her by the leg.” Another newborn had to stay in the hospital for two weeks due to failure to thrive. The mother checked out on the third hospital day, left a number where we could reach her when the baby was ready to come home, and never once came back to see her child. I found myself feeling despair for these kids who would probably never know a stable home, have regular hot meals, somebody to read them stories at night. They were starting life in so deep a hole that most of them would never climb out. Initially I felt resentment and bitterness toward the parents but then realized that most of these teen-aged moms probably started out life in the exact same way 14-20 years ago. If I didn’t expect these babies to have the opportunity to make something of their lives, why would I expect anything different from the prior generation? It really is a vicious cycle. It was really a contrast from the private hospital where Angie gave birth to our four kids. It always seemed like such a happy place. There were wreaths on the doors with blue or pink ribbons. New grandmothers stood by the nursery windows, staring in wonder at their sweet new sources of pride and joy. Dads pulled up to the front doors in SUVs with fancy new car seats to take their precious bundles home. At UMC you have to call in social work to help you find somebody to send the baby home with sometimes. Of course this picture is not the case with all or even most of the babies I saw but it is enough to make you wonder how the future can be bright with so many of its members bound for misery and despair barring some unforeseen intervention in their lives.
The Children’s Hospital is the best of places and the worst of places. There are kids who are so sick that they will never go home and others who will have almost miraculous care and get well. I don’t mean for this entry to be such a downer because overall my six-week peds rotation was a great experience. Most of the time and for most of the kids, it is a place of healing and hope. Having completed my rotation a week ago I can really see myself doing peds. I had a week in the newborn nursery, a week of clinic, and four weeks on the house team, and these last weeks were a lot of fun.
I followed a 7-year-old girl with a disease I had never heard of, dystrophic epidermolysis bullosa. This is a genetic disorder with a faulty gene for collagen VII which causes the skin to blister and slough off. Every tissue with a squamous cell epithelium is effected including the esophagus. This girl is admitted fairly often because of esophageal stricture secondary to her disease. She has lived her whole life on pretty much a liquid diet but sometimes her esophagus will blister and leave her unable to swallow so she needs parenteral nutrition and IV fluids. When I went in to see her on the night of her admission she was sitting up in bed watching a baseball game. Her Dad told me she loved the game and would watch any team that was on TV. Her parents had always sheltered her from playing sports because any kind of trauma can be devastating to her skin, but she talked them into playing softball this summer. The next morning I brought her a box of baseball cards and a card that one of my daughters made for her. When se got ready to go home, she gave me one of her softball pictures and a picture she drew. She was such a sweet and brave little girl.
I also met a little boy who was closer in condition to my son, Manning, than any other kid I have ever met. He had infantile spasms and intractable seizures his whole life. The same surgeon that did Manning’s hemispherectomy had dome a corpus collosotomy on this boy and he had been seizure free for a few months until the week of admission. He was only a year younger than Manning and had many of the same characteristics. He was floppy and weak but had those big eyes that made him look like he was somewhere far away. Maybe a place that is better than here. His mom sat on the bed next to his crib and made him a balloon from a latex glove. She wrote “I love you” on it and I could feel the aching that I get in the back of my throat when I think about my kids and Manning especially. She had adopted him at birth. I felt like I knew what the years had been like for her and how probably most of her friends knew what sacrifices she made but they probably still didn’t know what it was like for her at night as she lay in bed and listened to her little boy seize. For her the Children’s Hospital is a great place. A place where everytime you are admitted, the hope that something good will happen lies just around the corner.
Then there was the 15-year-old girl with Sturge-Weber who just wanted to get back to her high school basketball team. Her friends came to visit on a Friday night to fill her in on all of the school gossip.
There was seven-year-old boy with CF who hadn’t pooped in a week. He wasn’t about to let anybody stick an NG tube down him, but his belly hurt so bad he promised to drink the GoLytely if they just would get that tube away from him. And he did. 2.4 liters worth over 24 hours. When I asked him the next morning how he felt he said ,“Great!” I asked him how many times he went to the bathroom during the night and he told me had lost count. The most important thing was that he was going home and wouldn’t miss the wrestling match at the coliseum that weekend.
The pediatricians are very good to work with from the attendings down to the interns. I met a lot of great doctors and learned a lot. While the attendings are all obviously very smart and serious, they seem like they have fun. The wear Batman logos on their lapels and have ties with smiley faces on them. We had “rounds” one day sitting in the hospital McDonald’s dining room having smoothies and carmel cake. They had a big rotation party for us at a local burger dive. And they all told me what a great job I was doing even when I couldn’t remember what day of Rocephin my patient was on. I am only one week into Medicine but it seems a world away from the Children’s Hospital. I miss it already.