The two faces of paediatrics

Paediatrics seems to be a specialty of two sides. Although I did a four week paediatrics rotation last year, it hadn't really struck me until now. Ever since I have told people that I am considering a career in paediatrics I have been warned me that paediatrics is frought with sad cases, but I have tended to brush that off. I don't know whether I was sheltered during my first rotation or just oblivious to it. I suppose I was probably caught up with the novelty of it and being let loose on real patients.

One one hand you have the children who come in really unwell and a few days later bounce back and get discharged. Like the classic bronchiolitis case who comes in on day four of the illness, you know that by day seven or eight he is going to be back to his normal self with nothing but a bit of oxygen and maybe some fluids in the meantime. These cases put a smile on your face because when they are discharged you know that they are going to make a full recovery and that the parents will thank you for the amazing treatment their child has had.

On the other hand you have the murky world of child protection and mental health. I've seen some very sad cases on the wards. The ones that have struck me the most are the three cases of paracetamol cases in young girls and a young mother poisoning her baby by breastfeeding. The case of breastfeeding is really sad, the mother takes recreational drugs but is also trying to be the best mother she can by breastfeeding. Unfortunately this means that she is poisoning her new born child. The mother was clearly trying to do the best she could for the child but this poses a dilemna to medical staff. Should the baby be allowed to return home with the mother, even if the mother stops breastfeeding having a drug addict as a mother is not good for the child. On the other hand the mother clearly cares for the child because breast feeding is much better than bottle feeding and she took the time and effort to do it. 

The cases of paracetamol overdose had a greater effect on me. I have a younger sister who is a similar age to all of these girls and seeing them lying in bed with cannula's in their arms, having tried to take their own lives was heartbreaking. It really made me think what has happened to these young girls that they feel bad enough to try and take their own lives. While these girls were lying in bed looking up at me, I thought what really differentiates these girls from my sister. They have their whole lives stretched out ahead of them and yet only a few hours ago all three of them independently made the decision to end it. 

My six weeks of paediatrics has now come to an end. Although these sad cases have taken some of the shine off my initial impression of paediatrics, it has in other ways strengthened my resolve. For in these cases you are literally giving someone their life back, they may not thank you for itat the time but hopefully they will come to terms with what has happened. In very few other specialities do you get the opportunity to give someone so many extra years of life and for that reason I still prefer paediatrics over the other specialities I have experienced so far.