by Ellen W. Sutherland, MD
Although my career began 19 years ago as a general pediatrician in a private practice, I have since morphed into a pediatric hospitalist and an entrepreneur.
My first commitment and passion is for my hospitalist practice. Since this practice is organized around a “shift” model, I also am involved as a partner in an after-hours pediatric clinic. Conse-quently, my day may vary depending on what hat I am wearing. Today, I wear my hospital cap.
At 5:30 a.m., my alarm signals the start of the day. I quickly jump into the shower, but the hospital pages me before I finish in regard to three nighttime admissions – an 11-month-old with a gluteal abscess, a 14-year-old asthmatic whose name sounds familiar, and a neonate with fever. Today I also will be busy with the other 15 patients already on our service.
As I stroll through the emergency department at 6:45 a.m., I speak briefly with the staff about last night’s admissions. I’ll start with the teenage asthmatic on continuous albuterol. His name is familiar since this is his third admission in two years. Despite previous asthma education, he is not on any routine medications. His single mother can no longer afford them because, after getting a better job, she no longer is eligible for Medicaid. I call the social worker about help for this family.
By 8:30 I have completed the other two histories and physicals. After reviewing the labs on the neonate, I explain to the nervous parents that their baby does not have meningitis. They are so relieved and seem to understand the need for antibiotics until the culture is negative. The surgeon calls back and will take the 11-month-old with the abscess to the OR later today for incision and drainage. I am sure this will be yet another case of methicillin resistant Staphylococcus aureus.
Rounding on those other 15 patients begins in the intermediate care unit, with a 6-month-old former 26-week premie admitted with failure to thrive and aspiration pneumonia. The swallow study confirms a poor suck and severe gastroesophageal reflux. After a long discussion with the mother, I contact radiology to place a nasojejunal tube for safe feeding and again call the surgeon to evaluate the infant for a fundoplication and gastrostomy tube. I round on the other three patients in pediatric intermediate care (an improving asthmatic, a chronic seizure patient in for a video EEG and medication adjustments, and a 5-day-old infant being evaluated for an apnea).
At 10 a.m. I meet with my partner who is my back-up. We divide the four patients scheduled for discharge. She also will see a stable patient with osteomyelitis who is getting a PICC line so he can complete his course of IV antibiotics at home.
A PICU doctor pages me to accept a patient who is ready to transition out of the unit. After a brief report, I head off to the pediatric floor see the remainder of our patients. These patients have typical medical problems including pyelonephritis, vomiting with dehydration, croup, asthma, bronchiolitis and pneumonia. I have to be efficient since I have a medical executive meeting at 12:30 p.m. Fortunately, the meeting lasts only an hour, and lunch is served. After the meeting I review the chart of the PICU patient, meet the family, examine the child, and write a transfer note.
In the afternoon, the hospital call center connects me with a physician in Laredo regarding a child with fever and a rash. He is concerned about possible Kawasaki’s disease. I accept the patient and our transport team is dispatched to bring him here for evaluation. Since the patient will not arrive until at least 8 p.m., I call my husband who assures me he will pick up our two children at school and feed them dinner.
The rest of the day is filled with typical clinical duties.
I contact a few primary physicians, tend to my medical records and recheck patients seen earlier in the day. The ED calls about a 6-month-old with an unexplained fracture. Child Protective Services already has been called, but the child needs admission. Although the child is clinically stable, I need to look for evidence of any other trauma and CPS has to investigate the situation.
This type of patient always causes an ache in the pit of my stomach. After arranging for a 24-hour sitter to monitor the patient, I phone the ophthalmologist, consult the orthopedic surgeon and order the appropriate radiological studies.
In the event I am called to court, I am very careful to fully document all my findings.
Before the patient from Laredo arrives, I do physicals on two healthy newborns. Seeing healthy babies improves my mood from that CPS case. Unfortunately, one of the newborns is born to a 16-year-old mother who had no prenatal care. I have kept our social service personnel busy today!
The patient from Laredo arrives, and the history and exam is consistent with Kawasaki’s. His echocardiogram will not be performed until morning, but the standard intravenous immune globulin and high dose aspirin therapies are started. The difficult part is explaining Kawasaki’s to the family who speaks only Spanish. I rue the day that I never learned Spanish well enough to explain medical issues to parents.
Before leaving the hospital, I contact my partner who is on call tomorrow. After giving her checkout, I complete my billing sheets. By the time I arrive home it is 10:15 p.m. The night is not over, however, because I am responsible for our patients until 6 a.m. After working at the computer, I fall into bed at midnight.
During the night I am wakened by the ED about two admissions, and nurses called twice more with questions. Tomorrow I will be back at the hospital for part of the day as backup.
In the afternoon I’ll change into my other hat.
At 2:30 p.m. I’ll go to our after-hours pediatric clinic – Good Night Pediatrics. I’ll see “bread-and-butter” acute care pediatric patients until 11 p.m. It is a nice change from the demands of the hospital practice.
At the end of each exhausting day, I purposely recall an experience I had in an elevator one day. As I entered, I smiled at the only other occupant, a woman whom I did not recognize. As the doors closed she exclaimed in excitement, “You’re Dr. Sutherland, aren’t you?” When I confirmed her suspicion, she proceeded to thank me for saving her niece’s life. I did not admit that I could not remember her niece, and I was certain I had not saved her life. I surely would have remembered if I had.
For doing something in the course of my day that I must have deemed routine, this family had elevated me to heroic status. What other profession could possibly touch lives in such a special way? With this in mind I eagerly look forward to another exhausting day.
Ellen Wood Sutherland, MD is a pediatrician who divides her time between a hospital practice and an after-hours pediatric clinic.
