My seventh rotation was pediatrics at Queens Hospital Center. My rotation was split into several different settings. For three weeks I worked in the pediatric emergency department. During these weeks I worked three twelve-hour shifts on different weekdays and weekends and with different attendings. While some of the attendings I worked with were from the adult emergency department, most were trained in pediatrics, which was beneficial for my learning. For many of my shifts, I would have an examination room for myself where I would take the history and perform a physical on the patient. I would then go to the attending’s exam room and discuss the case. We would then go into the room together and the attending would also perform a physical, ask any additional questions and discuss next steps to the patient and/or parents. I was fortunate to have some autonomy during these shifts by performing history and physicals and performing a variety of procedures including abscess incision and drainage as well as laceration repairs. I also enjoyed watching the pediatric nurses obtain intravenous access in young children, which can be extremely difficult.

In the subsequent two weeks of my rotation, I spent a few days in the pediatric clinic and a few days in the NICU. This was a unique rotation in that it afforded me the opportunity to see several different aspects of pediatric care. Even while I was in the clinic, not only did I work with primary care pediatricians, but I also work with a geneticist, hematologist, neurologist, and cardiologist. The variety gave me a unique experience that I would not have had if I was rotating solely in a pediatrics primary care clinic. I was able to listen as the hematologist spoke about macrocytosis to a young child and her father, primary care pediatricians discuss weight-changing habits and the genetics doctor discuss Poland syndrome.

One experience that I will remember was a fifteen-year-old male who had testicular torsion while in the emergency department. The patient came in vomiting and with lower abdominal pain. On examination, the attending found that the patient had left-sided scrotal pain with tenderness, edema and an absent cremasteric reflex. The patient was immediately brought to have an ultrasound of his testicles and was found to have decreased flow to the left testicle. This case was memorable as it was a true emergency case, as testicular torsion can result in loss of the testicle if not surgically corrected with an orchiopexy in about six hours. The patient was brought emergently to the operating room at the hospital. Since this is a disease, we learn about several times while in school, it was beneficial for me to have a real clinical case. Additionally, I learned the importance of doing a genitourinary exam in patients with abdominal pain, because as was the case in this patient, he thought he had abdominal pain radiating to his scrotum and did not think it was the other way around. Therefore, it is important to do a full exam in patients, so you do not miss a serious diagnosis like torsion.

Another memorable experience from this rotation was with another patient in the emergency department. A young female patient came in for a cough and congestion for several days. A chest x-ray was ordered, and the patient had to do a urine pregnancy test, which came back positive. The patient did not know she was pregnant until I had to discuss the results with her. This was an informative experience for me because it allowed me to break this news to the patient independently and allowed me to console and provide support for the patient. I discussed the options that are available for the patient and provided follow up with OBGYN so she could establish care and decide her next steps.

I was incredibly grateful to have attendings that were willing to teach or review when there were a few spare minutes. This rotation allowed me to learn the acute nature of the emergency department and what questions are pertinent and life-threatening. On the opposite end, I learned the routine labs, questions and growth charts that are assessed during the pediatric primary care visits, as well as the psychological support that some parents need for patients with developmental delays or cerebral palsy. I also learned about the importance of certain questions in the NICU and providing support for parents of newborns. I will continue to use the knowledge I gain from these various aspects of pediatrics, such as in-depth history taking skills, as I move onto my next rotation in internal medicine.