What happens in the ER stays in the ER!

So, since last November, I have been helping Children's HealthWatch with collecting data on children ages 0-3 and their growth and nutrition in Baltimore City. I have had a lot of crazy experiences in the pediatric ER and they have been totally different each time.



As many of you might know, it's quite a maze getting into the city and parking is always an issue. But today, I decided to park in a local area across from the major city streets. So it was all good!

Sometimes, in the pediatric ER, we have suicidal patients, some noncompliant mothers, seizures, swallowed coins and much more! I look forward to my shifts on Saturdays because that's when most of the drama happens.



Today, there were two men who rushed in with a boy who was having seizures. Frantically, they waited as the ER nurses and doctors looked over the child and tried to figure out what was causing his seizures. They faces reflected intensely worried emotions. I was quietly observing, trying not to make it seem obvious that I was interested in what was going on. I hadn't had any surveys so far because every potential patient was either a refusal or just not available. This new emergeny event caught my attention and I wanted to know what they were up to in that small ER room.



I guess I would never know what EXACTLY happened but it got me interested in the causes of seizures in children.

I had an inkling that it could've been a febrile seizure because I overheard that it was accompanied by a fever that the child had the night before. His seizure had lasted about 10 minutes...and I guessed that the child was about 2-3 years of age. He also had taken a shot the day before but that's all I knew.

A lot of things can cause seizures, including infection, drugs, metabolic disorders, medications, disorder in blood vessels, or bleeding inside the brain. I am, by no means, a doctor (yet) but I can hypothesize that it was either due to the shot that he recieved or the fever that he had before due to an infection.

I hope that he recovers and that they quickly find out the reason of his seizure.

Hope you all have an awesome Saturday!

The World of Addiction Medicine [Part 1]

I had a wonderful day shadowing Dr. T at his center for addictions. I mostly sat with him in his office and conversed about how he got involved with addiction medicine and the intricacies of the specialty. He spoke about buprenorphine and methadone both of which are used in treating opioid dependence. I also learned that addicts do not necessarily possess any specific character flaw which would lead them to abuse. They are not "bad" people as society incorrectly propagates. Their addiction is their disease and they have no behavioral control of when to stop even though they may want to.

Dr. T compared addicts to diabetes patients; put a gun to a diabetic patient's head and tell him/her to lower his/her blood sugar at that instant. Doesn't seem reasonable does it? Addiction is truly a disease.

[Side Note: Dr. T is not under the chains of insurance companies and therefore, he can spend as much time as needed with his patients]

The first patient was a young looking strong man with a stern face. His urine test had proven to be positive for methadone, which is essentially a narcotic, and Dr. T was very upset. In the past, this patient's urine had been positive for various drugs (6 times to be exact). The patient pleaded that he had no idea that methadone was a narcotic and said that his friend just gave it to him (rigggght). Dr. T threatened not to see him again if his urine test was positive for narcotics or any other drugs. He called it, "tough love". Dr. T explained how most addicted patients are pathological liars and that he assumes all of his patients lie to him about how and why they take drugs. This is not because he dislikes them, it's the only way that he can effectively treat them without having himself be manipulated. He definitely knows how the addicted mind works.

The second patient was a 22 year old woman who was pursuing a nursing degree but had been out of school for almost a year and a half. Since she was 12, she had been on various pain medications for her supposed lime disease and uneven hip placement. She later found that she had a vitamin D deficiency and was taking meds for depression and pain management. She had a family history of addicts and her uncle had recently died due to alcohol poisoning. Dr. T assured her that he would be able to help her but not cure her addiction to narcotics for pain relief. [She had been using for over 10 years and addiction to opioids is NOT curable, only treatable]. Dr. T finally prescribed her oxycodone and told her that the time of intake didn't matter because it essentially had the same effect if taken in the morning or night. She asked about pregnancy and the effect of the medication on the fetus. At this moment she became extremely teary eyed and realized that her use of opioid inhibitors would cause the baby to be addicted from birth. Dr. T informed her that yes, her baby would be born addicted but a week's worth of detoxification would help the baby live a completely normal life. I get to see her again next week for her weekly followup.

Finally, the third patient was an old female patient from 2007 who had relapsed and started self medicating from a friend who was giving her oxycodone. Dr. T was intrigued as to how his patients were obtaining so much oxycodone (as much as thirty tablets) from "the streets". She needed to increase her dose and needed more tablets. Also, she told the doctor about her husband's renal failure and how she wanted to give him her kidney. Dr. T focused on her addiction issue, he provided her with enough oxycodone to last her a couple of days because, due to the economy, she was unemployed and was not going to receive her unemployment check until a week later. She was asked about the cause behind her relapse and her recent medical history. She had both of her knees replaced through surgery.

I definitely had a GREAT time with Dr. T and will keep you informed of all my happenings with him. He gave me his book to read on addiction and it's amazing how there is so much brain chemistry associated with it that previously was disregarded. My perception of addiction and addicts have completely changed and I'm glad that I was able to have this experience. =D