Catch 22

So if you havn't been following you'll have to read "The Art of Medicine" on my blog to get the full story.

Yesterday I was too tired to talk about it, but there is a child that I've been increasingly concerned about, the one from the previous post. Yesterday, I got a laboratory value back that along with this little one's physical presentation and reaction to previous therapies basically gave me the "ok" to order a chest Xray (I knew I was going to hear it from my attending if I was wrong because he told me not to), but I really thought something else was going on in this baby, something more than the same old, same old that I'd been told to wait and see about. When the Xray came back I KNEW there had to be something there (really I was thinking pneumonia)...but when we got the Xray back it looked exactly the same as it had two weeks ago.

So as rounds came closer and closer...the dread grew more and more. I had been instructed that this was just something the baby would have to "grow out of" and that I shouldn't subject the baby to further radiation (not that it's super dangerous - just a good practice). I was worried that this action would reflect badly upon me, that it would show I had no respect for my attending and his experience...I was preparing to get grilled. However, when rounds came and the CXR was pulled up, all I was subjected to was a very friendly lecture on how as a resident he would have done the same thing and that this was all about what they called "the art of medicine" something I'd already lectured myself about on this blog! To myself, I cringed that I hadn't learned anything about patience...or patients and that I'd soon be writing again about how I jumped to conclusions ect ect. But, then the radiology report came back.

It read basically that the lungs had slightly more fluid on them than last time and the heart was abnormally larger (albiet by just a small amount). This promted us to order a cardiology echo (a fancy ultrasound of the heart)...which showed the heart wasn't exactly as it had seemed...possibly more troubling was it had picked up an incidental reading of a vascular anomoly in another organ that could possibly explain her lung's resistance to our "normal" therapy.

Well the tests are still pending, but regardless, I feel validated that the child wasn't the "same old, same old" that we had thought, it feels good to not feel crazy or inept...better than that, it would be great if this led to helping this little rascle do better...cause she isn't doing that great right now, and honestly it's freaking me out.

*A side note, I was really impressed how cool my attending was about me ordering the test, ect. (I had previously apologized for ordering it) He told me I had nothing to say sorry about and the CXR may end up helping this little baby out after all. It was very impressive and said alot about him, that ego and arrogance don't drive him to do what he does and that he's all about helping his patients and teaching new doctors...I hope one day I can be like that (although it seems like Everest right now).