23 yo White Female with chronic abdominal pain, insomina and an obession.

There is an ache in the pit of my stomach. Its familiar although not comforting. Its the sort of ache that wakes you from a really wonderful dream  and you sit up in bed and wonder if holy snark I was supposed to be at work an hour ago.  Then you look over at your alarm clock and see Oh Thank God its only 3Am I can sleep a little longer. But the thing is you don’t want to sleep anymore because of the ache and the adrenaline now flowing in your veins.

I get this ache when I see something that is frighteningly awesome and completely unavailable to people who really need it. It wakes me from my American, middle class, over-educated dream to the reality of oppression, poverty and injustice. I had this on Saturday at the free clinic with the little girl who needed intervention and parents couldn’t afford it.  I had this ache on and off for the past month.  Part of my pediatrics rotation is a community health project. Mine focuses on chronic illness and disability. I have visited special education classroom, an augmentative communication lab, home health visits for kids on vents and NICU follow up.

I can’t help but look at these kids and see faces (and some facies), glimpses of lost children who live a half a world away.  I can’t help but compare. I can’t help but mourn the lost of so many who had thoughts, ideas, lives to share with the world. I can’t help but feel the wieght of the prejudice as I see what can happen in a world where it doesn’t exisits. I know that there is a lack of resources and I don’t expect American early intervention and rehab technology to translate perfectly into Eastern Europe and the former Soviet Union (or elsewehre for that matter).  But of a lack of resources does not justify the horror of letting a child with a heart murmur (insert: Downs, CP, Not Cute (seriously), Sticklers, Clef Lip, Deaf, Club Feet) rot developmentally in a institution.

That horror is ever more acute and repugnant when contrasted with what could be, with what is in another world.

Its an ache thats not going away.

pediatricians do it better

really why would I ever want to do anything but Peds: in no particular order

1. Kids are less smelly than adults.

2.  Actual acknoweledgement that 60% of medicine happens outside of the world of science in the realms of family, community, culture and ecnomics.

3. Kids don’t do it to themselves.

4. You can tickle your patients and not get charged with assult.

5. You get to help parents be beter parents.

6. BABIES.

7. You actually can have a life outside of medicine if you want it.

8. There is still time to help your patients make good healthly longterm choices.

9.  Your patients are resilient, most often happy and will forgive most painful procedures with the offering of a sticker.

10. Part of your physical exam includes tossing balls, hopping on one foot and drawing.

11. Your patients will outlive you and so will your life’s work.

12. Did I mention that they let you play with babies?

13.  You actual get to be a little bit creative from time to time.

…and now I have to go to clinic but I could go on for hours.  yep life is sweet. So sweet that during my pediatric clinical skills exam today, I actually marveled at the fact that I was having a good time taking a test. Seriously….

Drinking the Kool Aide or atleast sampling it.

A group of churches including mine have come together here in Winston and started a free clinic. Its held at my church once a month. Today was the first day I have able been to go in a while.  This was the week in NC where all kindergartners who had not previously filled out their physical forms got a letter saying they would be kicked out of school if they did not get a physical and vaccinations. The clinic was a mess.  I was hurried to a room given a file and told to just do whatever needed to be done, the doctor would check behind me.  Honestly if we had a first year medical student I think they would told them the same, we were desperate. So I threw myself into exam after exam of  5 yr olds who ranged from terrified to crawling up the walls.

About half way through the morning, a family with two kids, 4 and 6 came in. The Mom hands me a giant pack of papers, her daughter has just started kindergarten and has already been suspended for hitting the teacher. I take a good development history and undercover she had a global speech delay at 3 (as in not talking at all) and has only seen a doctor once or twice in her life. The parents can’t afford insurance because they both work they don’t qualify for Medicaid. The little girl is running around the room in circles one second or in her Dad’s lap messing with his face the next.  She doesn’t seem to understand my questions or instructions, she fails her development exam across the board, its obvious she has a global delay. Her Mom thinks its ADHD, I know that its far more than that. This is a free clinic. We give vaccinations, we do acute care, we even monitor BP and Diabetes a little bit but we can’t help this little girl. She needs a developmental pediatrician referral and is going to have a long medical journey one that we are already at least 3 years behind on. The window for early intervention is gone.

Its maddening. These people aren’t unemployed, they love their kids, they most likely are not criminals or dealing drugs, they are part of the PTA, they go to church and they don’t live in some god forsaken corner of the world, they live in America.  Yet they can’t afford health insurance and they don’t qualify for assistence.  So who suffers because of this? This little girl does, so does her family but don’t think it stops there.  Her teachers suffer having to deal with her behaviors and society suffers because we get to pay for it if she ends up in trouble legally or ends up on assistance later because she drops out of school or can’t stay employed.

For all the resources we have in this country, are not our children among our most valuable? Are  they not the ones who will run this country in 25 years?

In the mist of  Sarah Palin action figures and all this talk about hope and change…I sit in muggy NC  with tears of fustration in my eyes because from my point of view my country cares more about the value of a barrerl of oil than the life of a child.

life yeah.

I keep writing blog drafts and then not publishing them because well they stink. Life is sweet right now though. I am on pediatrics and loving it. I could have stayed in newborn nursery forever. It is impossible to be unhappy when you are surrounded by tiny brand new perfect little creatures.  It is amazing to watch them grow and change and develop into little people. So  yeah I have found my calling for sure and for some reason I have no profond things to write about.  Give me a week or two perhaps I will have less writer’s block.

Beyond that, its nearly Fall which is my favorite time of year. I am i the mist of being in charge of a church mission trip to Romania which is cool to be sharing my passion for empowering street children and orphans with my faith community but scary because I am sort in charge of 20 Americans in the developing world. I am sure there will be some good stories.

as always I have lots of studying I should be doing, so I cam going to get on that.

when my worlds collide questions emerge

How important is it to be 5′3???  I of all people should have an answer. I am sort of walking medical mystery. A dwarf in terms of genetics who never fell off the growth curve. My family with its hybrid of medicine and religion has its theories, as do the physicians.  I grew up being told I would be some where around 4 and half feet. Being little was not a scary concept for me, I had friends who were little. I realize as always my bias.

Today I met someone who has another genetic variation far more common than mine, she has one X chromosome (Turner’s Syndrome for the medically inclined). She is of short stature and is now on growth hormone shots once a day. She hates them. (she is quite young) and they might not even work. In the back of my mind, the part that has existed before the medical school brainwashing, I said why are we doing this???  What is so terrible about being little? I mean it has its social challenges but medically there is not much we are fixing.  Dont get me wrong the social challenges are REAL, I consul teens with the SED/KNIEST group about it. But the same voice in my mind shouted some of the social challenges are societal…classic medical model thinking.  It wasn’t so much that I disagreed with the decision as it was I disagreed with the absoluteness of it. Growth Hormone is what you do for THIS.  THIS is obviously a disease, a medical problem.   A medical problem according to whom?  Turner’s itself has some other complications that I would classify as PROBLEMS but short stature I think of as variation. Injections of growth hormone every day is not entirely a benign procedure physically, risk wise and psychologically. Is it worth it?

Would I have taken it if I had the choice? The answer is probaly not but it was because I was brainwashed to believe that height was not important.  Its all about perspective.

What if the biggest enemy in the exam room is not the so called disease but our perception of it?

yeah we all see why medical school is problematic for me at times.