This is the second post in my blog about my experiences as a pediatric resident. It has been some time since my last post, but it has been an intellectually and emotionally-enlightening several weeks. I finished my time on the main patient floor, and saw pathology that further reinforced why I decided to make this residency program my home. What I found most interesting was the two weeks I spent on the floor at night. There, I was alone with a second and third year resident to run the patient floor and treat over 30 patients. It was initially an intimidating process but being responsible for so many patients without the support of a comprehensive physician team forces you to make decisions for the first time that could significantly impact the course of a patient's health. I constantly thought back to my night shifts during my 3rd year clerkship at TeAMS, at the pediatric department at Ha'emek Hospital in Afula, Israel. One of the residents I worked with encouraged me to calculate important vital signs and make calculations for the fluid requirements that patients would need when entering the ER. Thankfully he persisted to make sure that I was comfortable with making these calculations. That played an essential role in ensuring that I knew how to place orders for patients and make sure that patients were hydrated on the floor, even during an emergency. That was particularly clear when I had to work with a patient that had a fever of 105F and had not eaten or taken in fluids for over 24 hours. Given that he was also vomiting and having intermittent seizures, it was important that I take into account all of the orders necessary to stabilize him. I was able to maintain the patient's health overnight with the help of the other residents and luckily the patient was discharged a few days later in much better health.
Although intimidating, this event reminded me of why I wanted to be a doctor and why I wanted to be a pediatrician. I get ready to start working in the NICU, pediatric surgery unit, and pediatric ER in a few weeks, where I will be responsible for efficiently triage patients and thereby deciding whether they need acute care, chronic care, or hospitalization. The hospital I work at is a central Brooklyn hospital with a comprehensive pediatric emergency room. Because of this, it is a very busy ED, and it is absolutely important to remain alert despite the long hours that I will be working. However, I feel prepared for the rotation, and I am excited to start because it is one of the specialties I am strongly considering as a possible fellowship after I finish my residency. One of the main reasons for my enthusiasm and preparedness was my experience working in the Pediatric ER at Rambam Medical Center in Haifa. I worked with the head of the department, Dr. Itay Shavit. He strived to keep the emergency room efficient at all hours of the day and night, and his drive for professionalism and improved clinical care in an acute setting was inspiring. I still remember a busy night in the ER when the whole team was overloaded with patients. Despite this, we were attempting to suture the head of a patient with developmental delay and agitation. While effectively designating tasks to each member of the team to take care of the entire floor, he also managed to combine both calming techniques (DVD/music) with mild sedation to suture the patient successfully. Watching all this, I learned a tremendous amount, and I will take that with me to try and at least effectively manage my own patients on a smaller scale when I am in the ER.
David Steffin, M.D.
Pediatric Resident, PL-1
Maimonides Infants and Children's Hospital of Brooklyn
Technion American Medical Program, 2012