Editor's Note
Little Bodies, Big Challenges
Although I’m a big people doctor, I came close to caring for wee ones. In medical school, I did an elective rotation, during which I served as a pediatric extern with virtually the same responsibilities as interns including taking call by myself. I admitted kids with croup in the middle of the night; learned to find almost nonexistent veins for IVs in hands, heads, and feet; and, most terrifyingly, answered emergency calls from the delivery room to resuscitate a floppy newborn who wasn’t “pinking up” properly. Despite those ulcerogenic moments, I loved taking care of kids, who even at their sickest somehow had a spark of spontaneity rarely seen in adults. Their powers of recovery were spectacular. And the playful ambience of the pediatric ward with its stuffed animals and coloring books was a daily upper.
In our internal medicine office, we have potted plants instead of building blocks and The New Yorker instead of Curious George. Yet there is a certain similarity between my elderly patients and those kids I saw years ago. Faulty and failing memories provide the same challenges as 6-year-old distractibility in getting a coherent history. Depends look a lot like Pampers. And grown children become the “parents” who transport, translate for, and tend to their elderly loved ones. Sometimes the circle of life seems dramatized daily in my waiting room.
Pediatric medicine also has parallels to internal medicine. When kids hurt, they need adequate pain medication just like adults do. When they’re depressed, they need pharmacologic or talk therapy or both. Like internists, pediatricians are learning they need to consider the whole person including the mouth. But internists could take a lesson in preventive medicine from pediatricians with their model of well-child visits and routine vaccinations.
Yet, medically, kids aren’t just little adults. From their first breath, they have different needs and distinctive problems.Glitches in their genes may first surface in the newborn nursery, and an expanding battery of screening tests promises to find those glitches sooner, allowing physicians to take action. Children are subject to a panoply of illnesses never encountered in adults, some with colorful names such as maple syrup urine disease or ultra-
polysyllabic ones such as ornithine transcarbamylase deficiency. When kids reach that mysterious time of life called adolescence, they present a complex skein of medical and psychological problems that can test their doctors almost as much as their parents.
Pediatricians’ successes have presented new problems for other doctors. As patients with previously fatal childhood diseases such as cystic fibrosis and childhood malignancies reach adulthood, they outgrow the toys in the pediatric waiting room and move on to doctors for adults, who now need to learn a new set of skills to tend to this unique group of patients.
My decision to shun pediatrics came during a daylong visit to a private practice pediatrician’s office. What I witnessed was a virtuoso performance of multitasking—examining a screaming infant while talking to a frazzled mother, answering phone calls from frantic parents while scribbling hasty chart notes, and juggling the preventive and acute needs of kids of all ages. Although I have since learned to multitask in my own meager way, I don’t now, and certainly didn’t then, think that I was equal to the challenge of pediatrics. Taking care of wee ones is a big job.
Charles R. Meyer, editor in chief
Dr. Meyer can be reached at cmeyer1@fairview.org