Friday, January 21, 2005
i'm just going to buy a hazmat suit
I'm glad I'm finally able to tell people now about Cletus the Fetus, because let me tell you, it was hard to keep a secret of that size. (Not that Cletus is huge--7.4cm crown to rump on the latest measurements--but I meant a secret of that magnitude.) Hard to keep the secret at work, from people who see me every day, but also hard to keep the secret here, where I tell all my stories. Because being a Peds resident while pregnant is a little bit like being an FBI trainee going through the training course at Quantico. There are hidden dangers everywhere. Or so it suddenly seems.
I'm not just talking about obvious things, like walking into the CT scanner while it's running, or getting nailed in the gut but some deranged teenaged psych patient. I'm talking about things that you learn about in med school. Seemingly unimportant at the time, but let me tell you, you'll be yanking out those old med school notes soon enough to re-read about first trimester exposure to CMV when you're pregnant too and hanging out with a passel of CMV positive drooly little suckers.
How, for example, to handle children with rashes. I know an ER attending who, while pregnant, absolutely refused to see any child with a rash. I think that's a little extreme--I mean, I don't think eczema's going to cause your unborn child to lose any IQ points, lady--but I guess her point is that you never know. Anyway, attendings can do whatever they want, but the idea that a resident could pull of such refusal in the ER is just unthinkable. Because when it comes down to it, ALL CHILDREN HAVE RASHES. It's just a matter of staying away from the suspicious ones. Unfortunately, we're usually the ones who decide if the rashes are suspicious or not, and usually by the time I get close enough to do that, the kid is already eating my stethescope and innucolating me with boogers. And sometimes it's a surprise rash. Like in clinic a few weeks ago, I saw a kid for croup. At least, that's what it said on the chart. But when I walked into the room, I see a kid with slapped cheeks and a lacy maculopapular rash all over his torso. Ah-so. Yes, yes, I know they're not supposed to be shedding anymore by the time the rash appears, but it's difficult not to stress about it when it's your own fetus at stake. Luckily, my OB is very good (or perhaps well-accustomed to taking care of patients who are doctors), so on my first visit drew titers for everything under the sun. After I walked out of the patients room, I ran to a computer and checked my own results. Thankfully, I'm IgG positive for both parvo and CMV (meaning: immune), but I challenge you to not freak out about that kind of thing when you're pregnant. Freaking out is the nature of the game.
Or how about on oncology? Taking call for oncology forced my hand to tell people at work about Cletus. I mean, I was ready to tell anyway, but I would have liked to do it nice and calmly, maybe over a cup of hot chocolate, not because there's some kid getting Ribavirin and one of the things on the signout list reads, "Please place ND tube overnight." Oh, hells no. Ribavirin, for those luckily uninitiated, is an inhaled med that we sometimes use for immunocompromised patients with RSV. It's also Pregnancy category X, meaning that on the door of the patient on Ribavirin is a gigantic red sign that reads DO NOT ENTER THIS ROOM IF YOU'RE PREGNANT, THINK YOU MIGHT BE PREGNANT, OR EVER WANT TO BE PREGNANT IN YOUR LIFETIME. (Well, maybe not that last bit.) Because it's extremely teratogenic, you see. And it's aerosolized, so the kid getting Ribavirin has to be all sequestered off in some little negative pressure room somewhere. Let me tell you, that stuff is scary. No one is supposed to go in while the treatment is running, but even after it's done, that stuff hangs around. Last year on Onc, I went in to examine a patient on Ribavirin between doses, and when I walked out of the room a few minutes later I was all dizzy and had a headache. Delightful.
Or how about Wednesday night on call. I'm in the team room when I head the shatter of breaking glass and a scream. It was Professor Plum with the candlestick in the negative-pressure room! I go running around the corner to see if anyone needs any help, and screech to a halt cartoon style three feet from where one of the nurses just broke a full bottle of chemotherapy all over the floor.
"I'll...tell the ward clerk to call Environmental Services," I stammered, backing away from the GIGANTIC PUDDLE OF LIQUID POISON, as the rest of the nursing team was putting up little roadblocks and flares around the spill and making little clucking noises of dismay.
So you see, it's a dangerous world out there. Or at least in here. At least this puts to rest the question of what kind of parent I'm going to be. The EXTREMELY NEUROTIC kind.
I'm glad I'm finally able to tell people now about Cletus the Fetus, because let me tell you, it was hard to keep a secret of that size. (Not that Cletus is huge--7.4cm crown to rump on the latest measurements--but I meant a secret of that magnitude.) Hard to keep the secret at work, from people who see me every day, but also hard to keep the secret here, where I tell all my stories. Because being a Peds resident while pregnant is a little bit like being an FBI trainee going through the training course at Quantico. There are hidden dangers everywhere. Or so it suddenly seems.
I'm not just talking about obvious things, like walking into the CT scanner while it's running, or getting nailed in the gut but some deranged teenaged psych patient. I'm talking about things that you learn about in med school. Seemingly unimportant at the time, but let me tell you, you'll be yanking out those old med school notes soon enough to re-read about first trimester exposure to CMV when you're pregnant too and hanging out with a passel of CMV positive drooly little suckers.
How, for example, to handle children with rashes. I know an ER attending who, while pregnant, absolutely refused to see any child with a rash. I think that's a little extreme--I mean, I don't think eczema's going to cause your unborn child to lose any IQ points, lady--but I guess her point is that you never know. Anyway, attendings can do whatever they want, but the idea that a resident could pull of such refusal in the ER is just unthinkable. Because when it comes down to it, ALL CHILDREN HAVE RASHES. It's just a matter of staying away from the suspicious ones. Unfortunately, we're usually the ones who decide if the rashes are suspicious or not, and usually by the time I get close enough to do that, the kid is already eating my stethescope and innucolating me with boogers. And sometimes it's a surprise rash. Like in clinic a few weeks ago, I saw a kid for croup. At least, that's what it said on the chart. But when I walked into the room, I see a kid with slapped cheeks and a lacy maculopapular rash all over his torso. Ah-so. Yes, yes, I know they're not supposed to be shedding anymore by the time the rash appears, but it's difficult not to stress about it when it's your own fetus at stake. Luckily, my OB is very good (or perhaps well-accustomed to taking care of patients who are doctors), so on my first visit drew titers for everything under the sun. After I walked out of the patients room, I ran to a computer and checked my own results. Thankfully, I'm IgG positive for both parvo and CMV (meaning: immune), but I challenge you to not freak out about that kind of thing when you're pregnant. Freaking out is the nature of the game.
Or how about on oncology? Taking call for oncology forced my hand to tell people at work about Cletus. I mean, I was ready to tell anyway, but I would have liked to do it nice and calmly, maybe over a cup of hot chocolate, not because there's some kid getting Ribavirin and one of the things on the signout list reads, "Please place ND tube overnight." Oh, hells no. Ribavirin, for those luckily uninitiated, is an inhaled med that we sometimes use for immunocompromised patients with RSV. It's also Pregnancy category X, meaning that on the door of the patient on Ribavirin is a gigantic red sign that reads DO NOT ENTER THIS ROOM IF YOU'RE PREGNANT, THINK YOU MIGHT BE PREGNANT, OR EVER WANT TO BE PREGNANT IN YOUR LIFETIME. (Well, maybe not that last bit.) Because it's extremely teratogenic, you see. And it's aerosolized, so the kid getting Ribavirin has to be all sequestered off in some little negative pressure room somewhere. Let me tell you, that stuff is scary. No one is supposed to go in while the treatment is running, but even after it's done, that stuff hangs around. Last year on Onc, I went in to examine a patient on Ribavirin between doses, and when I walked out of the room a few minutes later I was all dizzy and had a headache. Delightful.
Or how about Wednesday night on call. I'm in the team room when I head the shatter of breaking glass and a scream. It was Professor Plum with the candlestick in the negative-pressure room! I go running around the corner to see if anyone needs any help, and screech to a halt cartoon style three feet from where one of the nurses just broke a full bottle of chemotherapy all over the floor.
"I'll...tell the ward clerk to call Environmental Services," I stammered, backing away from the GIGANTIC PUDDLE OF LIQUID POISON, as the rest of the nursing team was putting up little roadblocks and flares around the spill and making little clucking noises of dismay.
So you see, it's a dangerous world out there. Or at least in here. At least this puts to rest the question of what kind of parent I'm going to be. The EXTREMELY NEUROTIC kind.
* * *
(Oh, and to clarify, we're not actually naming the kid "Cletus." That's just what we're calling it for now, because "Cletus the Fetus" is kind of funny. But I don't actually want our kid to grow up to be a slack-jawed yokel.)
Currently reading: Continuing on my effort to stall for time until I figure out the next new book to read, I think I'll truck "The Shining" up to work with me. Unfortunately, my copy of "The Shining" is part of a four-novel Stephen King anthology, so it's a little cumbersome.