Pediatrics at Karapitiya Hospital

In our second week at Karapitiya Hospital we were able to do inpatient pediatric medicine. The pediatrics (peds) ward is a much different experience than our adult medicine week. Here, there are several consultants that round on the ward, so the medical students and house officers are divided up into much smaller groups. For me, this was such a great experience because I got to round with Professor (Dr.) Jayantha who LOVES to teach. He was so wonderful in making us feel included as learners, spoke only in English- except to the patients of course- and PIMP'ed us just as hard (if not more so) as his students. For my non-medicine followers, PIMP stands for 'put in my place' and it's a method of teaching where the teacher (in this case Consultant) asks the student questions one after another basically until you feel like a total moron and can't answer any more or they're satisfied with your responses. Then you have to go look up whatever you didn't know and report back. Anyways, I learned so much from my few days on the peds ward- I'm getting better at reading chest x-rays, deducing what type of bacteria may be to blame based on physical exam and radiography, and how to do a proper neuro exam on a patient with cerebral palsy.

From left: Senior Registrar, Mollie, Me,
Professor (Consultant) Amarasena, Holly

One day we did rounds with Professor Amarasena who is also a fantastic and enthusiastic consultant and teacher. During rounds he asked me to inspect a child and examine him. All I knew about the child was he was there for a broken arm. It seemed strange that a child was admitted for that, so I figured something else was up. Dr. Amarasena specifically asked me to inspect and palpate the child's head. When I did so, I noticed that this 2+ year old child still had an open fontanelle. This should have been closed by now, so there was clearly something besides a broken bone going on. Prof Amarasena looked at all of us students and told us to write down 3 differential diagnoses for this patient. He then looked over at the 3 of us sweaty monsters dripping in our white coats and said, "You too. Write down 3 diagnoses and then we go snowboarding!" Huh? Holly and I looked at each other and our eyes both said 'did he just say snowboarding'? He laughed and said, "yes, we go snowboarding." Holly replied with "I'm good with that!" We were a little embarrassed that we were sweating so much. How is it that none of these people were sweating? They never sweat! They never drink water; they never pee; they never sweat! How is this possible? Anyways, we got back to inspecting the child for our differentials. I then noticed that the child had blue sclera (or maybe I was making myself see blue sclera because I had a pretty good idea what this kid had) and immediately my differential included osteogenesis imperfecta (OI). Luckily, I had done research on OI when I worked at Children's Hospital in Boston so when he started to pimp us on OI I was able to answer all his questions.  

Pediatric Ward

The hallway outside of the busy renal clinic.
The waiting room was stuffed full.

One disorder that I noticed commonly on the peds ward was nephrotic syndrome. This is much less common in the States and it was a great opportunity for me to learn something new. Professor Jayantha brought us to his renal clinic where we saw many babies and young children with pyelonephritis, UTI's and nephrotic syndrome relapses. The clinics here are jam packed with people lining up and down the hall due to an overstuffed waiting room. Once the patient's name is called, they are brought to our room. A basic exam room with no bed, no supplies, just a typical-sized doctor's office room with a dining table and chairs. There are 3 physicians seated at the table with 3 chairs by their side, ready to be filled by 3 patients. There are also 7 or so of us students and 2 nurses in the room....nice and cozy huh? I've been slowly getting accustomed to the heat and humidity of Sri Lanka, but wearing my heavy white coat and standing still in a room this crowded without circulation....this was the closest I had come to passing out during my training. I was literally touching shoulders with both Mollie and Holly and my back against the wall and half a foot away from the patient sitting in front of me. But, aside from the gray-screen that started appearing in front of my eyes, I did learn a lot about nephrotic syndrome and the various types- something I had know nothing about before. Prof Jayantha is very passionate about this subject as it is also his area of focus for his research. I'm not sure if it's Prof Jayantha's teaching or what, but I might consider pediatrics after all....

Saying that out loud (or writing it to you all) makes me laugh. It makes me think about how scared I was of doing well child checks during my primary care rotation. It seemed like such a big job to make sure you remember all the important educational points to discuss with the parents and to do an exam on a kid without making them cry, well that's a skill I didn't think I had in me. After doing my first few pediatric appointments and well child checks, my preceptor, John Sallstrom, asked me if I was sure that I didn't want to go into peds. Flattered, I laughed and said, no. But John, you may have been on to something!!! I think I'm digging this pediatric thing after all. Guess this is why we do rotations in every major area before we apply for jobs!