(no subject)
Being 5 weeks into my forth year paediatrics posting, I think I can say with some certainty that I would not become a paediatrician in future. It is not so much a problem of working with kids; I think I can tolerate sick irritable kids more than stubborn drunk uncles who smoke 2 packets of cigarettes a day. I think I will not become a paediatrician because it is just painful to witness the ordeal that some of these kids go through, and I cannot detach myself enough to remain unaffected by their unfortunate circumstances.
We go through the same cycle every day of our clinical postings. We roam the wards, pick up a case file hoping and crossing our fingers that it would be an interesting case or has significant signs. We know our patients by their diagnoses; Little J was CHARGE association, or CHARGE syndrome as some people wrongly put it. She is a 6 month old little girl with a significant history of CHARGE association and is now admitted for an upper respiratory tract infection. It propagates, the little girl in the corner of the cubicle with the coloboma, heart problems, choanae atresia, mental retardation,genitourinary and ear malformations. We clerk the mommy, we examine Little J, we discuss about CHARGE association, we read up about it and hopefully we will not forget about the condition or Little J ever again.
The "shitters, fitters and wheezers" we do not worry much about. We watch their hydration statuses, we abort their fits, we clear the inflammation in the airways and we discharge them. It is the Kabuki Syndromes, the Downs Syndromes, the Noonan Syndromes, the Digeorge's Syndromes that leave the deepest impression on me. They may be the esoteric, exotic cases we would never see again in our medical career, but yet they leave their footprints. I will always remember how KabukiKids have long palpebral fissures or eversion of the lateral third of their lower eyelids; or how Downs kids have simian creases and sandal toes; or how Digeorge's is also known as the CATCH-22 syndrome (Cleft palate, Abnormal Facies,Thymus hypoplasia, Cardiac, Hypocalcemia, due to gene deletion on chromosome 22q11.2).
And then the sadness comes. We know the asthmatics can be controlled, the GEs are part and parcel of growing up, chickenpox can be prevented by immunization. But these children with congenital problems did not choose to be born this way. Their cleft palates are not the result of them drinking alcohol and smoking; oral cancers in adults are. Their pulmonary hypoplasias are not a result of smoking 2 packs of cigarettes a day for 30 years; COPD in adults is. They acquire HIV not because they are promiscuous but because of vertical transmission from mother to child. And yet, they have to live with a ventricular septal defect (reparable no doubt, but not without major surgery. Some adults go from infancy to death without staying more than one night in a hospital bed wearing hospital gowns); they are mentally retarded; they have dysmorphic features making them the subject of ridicule. Yet they remain so cheerful and oblivious to their surroundings. When Little A, my patient with Kabuki Syndrome gave me the heartiest flying kiss I have received from anyone in a long long time, I felt really sad. Sad that she would probably not survive past middle age; sad that she has a complex cyanotic heart disease that threatens her life every minute of the day; sad for her parents who probably expected their child to grow up healthy, get married, have a successful career and family, but now will in fact, probably grow up different from the other kids they see in the playground.
And, all we can hope to do as doctors is to be able to diagnose these conditions early so we can manage the condition and watch for the complications. There is no technology available, and also not practical or beneficial in screening for all these syndromes antenatally. So we will continue to see the Rett's Syndromes, Angelman syndromes, Turner Syndromes around and there are probably many more yet-to-be-described syndromes waiting to be named after yet another observant paediatrician leaving his mark and probably an entry in Nelson's Textbook of Paediatrics.
Paediatric Medicine is a noble specialty. But I think I am better off with my scalpel in the OT, thank you very much. But for now, the greatest hurdle remains to be cleared. THE FINAL MBBS exams. And before that, there is a mini hurdle in the form of the Pathology professional exams to deal with. So for now the scalpel, the 22g intravenous plug, the Dextrose-Saline (Adult) can wait. The sun is also rising, and I shall head to bed.
With thoughts of Little J and Little A in mind of course. Rett's Syndrome is inherited in a X-linked recessive manner. It is a lethal condition in boys, and only affects girls... ...
We go through the same cycle every day of our clinical postings. We roam the wards, pick up a case file hoping and crossing our fingers that it would be an interesting case or has significant signs. We know our patients by their diagnoses; Little J was CHARGE association, or CHARGE syndrome as some people wrongly put it. She is a 6 month old little girl with a significant history of CHARGE association and is now admitted for an upper respiratory tract infection. It propagates, the little girl in the corner of the cubicle with the coloboma, heart problems, choanae atresia, mental retardation,genitourinary and ear malformations. We clerk the mommy, we examine Little J, we discuss about CHARGE association, we read up about it and hopefully we will not forget about the condition or Little J ever again.
The "shitters, fitters and wheezers" we do not worry much about. We watch their hydration statuses, we abort their fits, we clear the inflammation in the airways and we discharge them. It is the Kabuki Syndromes, the Downs Syndromes, the Noonan Syndromes, the Digeorge's Syndromes that leave the deepest impression on me. They may be the esoteric, exotic cases we would never see again in our medical career, but yet they leave their footprints. I will always remember how KabukiKids have long palpebral fissures or eversion of the lateral third of their lower eyelids; or how Downs kids have simian creases and sandal toes; or how Digeorge's is also known as the CATCH-22 syndrome (Cleft palate, Abnormal Facies,Thymus hypoplasia, Cardiac, Hypocalcemia, due to gene deletion on chromosome 22q11.2).
And then the sadness comes. We know the asthmatics can be controlled, the GEs are part and parcel of growing up, chickenpox can be prevented by immunization. But these children with congenital problems did not choose to be born this way. Their cleft palates are not the result of them drinking alcohol and smoking; oral cancers in adults are. Their pulmonary hypoplasias are not a result of smoking 2 packs of cigarettes a day for 30 years; COPD in adults is. They acquire HIV not because they are promiscuous but because of vertical transmission from mother to child. And yet, they have to live with a ventricular septal defect (reparable no doubt, but not without major surgery. Some adults go from infancy to death without staying more than one night in a hospital bed wearing hospital gowns); they are mentally retarded; they have dysmorphic features making them the subject of ridicule. Yet they remain so cheerful and oblivious to their surroundings. When Little A, my patient with Kabuki Syndrome gave me the heartiest flying kiss I have received from anyone in a long long time, I felt really sad. Sad that she would probably not survive past middle age; sad that she has a complex cyanotic heart disease that threatens her life every minute of the day; sad for her parents who probably expected their child to grow up healthy, get married, have a successful career and family, but now will in fact, probably grow up different from the other kids they see in the playground.
And, all we can hope to do as doctors is to be able to diagnose these conditions early so we can manage the condition and watch for the complications. There is no technology available, and also not practical or beneficial in screening for all these syndromes antenatally. So we will continue to see the Rett's Syndromes, Angelman syndromes, Turner Syndromes around and there are probably many more yet-to-be-described syndromes waiting to be named after yet another observant paediatrician leaving his mark and probably an entry in Nelson's Textbook of Paediatrics.
Paediatric Medicine is a noble specialty. But I think I am better off with my scalpel in the OT, thank you very much. But for now, the greatest hurdle remains to be cleared. THE FINAL MBBS exams. And before that, there is a mini hurdle in the form of the Pathology professional exams to deal with. So for now the scalpel, the 22g intravenous plug, the Dextrose-Saline (Adult) can wait. The sun is also rising, and I shall head to bed.
With thoughts of Little J and Little A in mind of course. Rett's Syndrome is inherited in a X-linked recessive manner. It is a lethal condition in boys, and only affects girls... ...