It's three days into my Trauma Surgery clerkship and I'm already onto the sleeping schedule of an 80 year old. I never had the chance to elaborate in my thoughts of Pediatrics, mostly probably because they were too depressing to write about. A combination of close friends of mine and random new acquaintances had to bear the brunt of those rants, unfortunately for them, leaving little more than a post on big macs here on this blog. Even though I've only been here three days, the gaping hole between the two clerkships is readily apparent. For one, people get better on the Surgery ward. Or the die. Either way, if they die we're probably going to give them a few more hours. Tertiary care pediatrics deals with kids who are really, really messed up to begin with, and all we can ever hope to do is solve their acute problem so they can go home and remain a burden to their family for another few years.
The breakdown is becoming apparent in terms of quality-life-years. Internal medicine is a specialty where great measures are taken for the sake of gaining 5-10 quality life-years for 70 year olds, or 5-10 numb years for 80 year olds. Pediatrics has the goal of possibly adding 50 or so years to a patient's life, but in a tertiary care facility such as the one I was at, the underlying disorder is bad enough to render these years a disaster, leading the primary caregiver down the awful path of convincing herself that keeping this child a live is a good idea in the first place. Trauma surgery, now, deals in terms of Quality Life Years, where all three of these terms are preserved to the utmost degree. A man gets hit by a sewage truck and pinned to the wall. 52 pints of blood and a few extravagant surgeries later, he has a chance for another 40 quality years. Man gets shot in the neck and once in the face. All it takes is an air tube and critical care, and this man can live another 60 good years. Now HERE's a field of medicine we've got down pat. For the first time since I've seen, the state of modern technology is helping save lives. Quality lives. That's something I can get into.
...but I'm three days in. Tomorrow is my call day. 5:30AM Friday 'till noon Saturday of serving on the team to provide the majority of Level 1 Trauma surgery in Los Angeles County on a Friday night. Also my first overnight call night at a hospital (definitely not my last). I'll have to wait 'till after this before I know what I think.