Froggie Asthma

Here's a story from my fourth year of med school as an A/I (acting intern)...

A/Is, also known as sub-Is, are fourth year med students who are doing a rotation in the field they want to go into as someone who is auditioning or practicing to become an intern the following year. This rotation is often one of our most important ones since so many of us want to look exceptional in our faculty's eyes so we might be able to get a stellar letter of recommendation for residency. For most pediatrics programs, we needed three. I got one from my internal medicine inpatient rotation (with the best faculty physician in the ENTIRE world), and two from my A/I rotation. Because I was am awesome.

While on that rotation, I was on the intermediate care unit. I took care of lots of kids who were too sick for the normal wards but not sick enough for admission to the PICU. I saw lots of kids with asthma. I got really good at recognizing how much longer a patient needed to be on the high dose albuterol nebulizer treatments and when it was appropriate to wean to a lower dose. I got really good at differentiating between good wheezes and bad wheezes and even bad wheezes that masqueraded as good wheezes. My stethoscope was my best friend during that rotation.

Out of all those kids, a few stand out and I don't think I'd ever forget them. One of my patients was in our hospital intermediate care unit for about 3 days... I'm not exactly sure how long he was there on our floor, but I know I'll never forget him. He was so sick when he came, and he was being pounded with continuous albuterol nebulizers and IV steroids. He looked absolutely miserable. What was even more striking is that this little 6 year old boy also had alopecia universalis, an autoimmune disorder that caused all the hairs on his body to fall out so he was completely bald and with no eyebrows. Anyways, asthmatics always require frequent lung sound checks since each one can respond to the treatment differently. Sometimes, they can respond quite quickly, only with one treatment, and sometimes it takes hours and hours of continuous treatment. After the third time I came in his room to check on him, he got used to me and seemed to be comfortable around me. His mom knew me by name by the end of the day. When I came back the next day, he was doing even better and was on a lower dose of medication every hour. He looked so much better too. He was able to sit up, play video games with his brother, and even talk about how much he loved robots and dinosaurs. By the end of that day, he was doing fairly well, but he wasn't improving as much as we had expected, so we had to go back up on meds. Unfortunately, this was a step backwards, and that happens all the time if someone's dose is decreased too quickly. His spirit stayed positive, and he even knew the routine whenever I walked in to check his lungs. He would sit up straight and lift up his shirt and say, "I'm ready!!" which made me laugh each time. The end of the second day was no different, and he did the same. His airways sounded much more open to me, and I told him, "well it sounds like you have a bunch of frogs in your chest who chased out all the mice!" He looked at me, nodded like what I was saying was no big deal to him, and nonchalantly said, "yeah I know, I put them there."

I love spunky kids.

Until the next one then.

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