basics

Words like emesis and metrodinazole roll off tongues and letters like PRN and BID are strung together as though they were ABC, and you might be fooled into thinking this is medicine. At the end of the day, you discover that it's not academic, it's visceral. First and last, your patients must be able to drink water, eat food, pass stool, urinate not too little or too much, and move as they did before sick (this can mean walking as freely as I do, or it can mean being able to get out of bed and back again).

There are patients whose every act of daily living is monitored, recorded, reported, and regulated. An anorexic is weighed twice a day and can only walk to and from her bed (but not repeatedly). A diabetic counts his calories and has his finger pricked four times a day to measure his blood sugar. A girl with cystic fibrosis breathes according to a wall-long schedule of physical therapy and treatments designed to clear her lungs. A shy boy with inflammatory bowel disease reports on his bowel movements: quantity, color, texture. The hospital does much of this for them: we supervise them, we stick their fingers with needles, we call physical therapy, and we position a container in the toilet. But they will have to go home and live, and in our qualifications for their leaving the hospital, we include their ability to: eat, drink, pee, poo, take care of themselves and/or be taken care of.

It's not easy to take care of your senses. Sometimes to do so, we corrupt them. One afternoon we taste-tested about twenty common drugs. The last smelled and tasted like rotten eggs, horrifying our taste buds long after it'd traveled past them. Another afternoon we tried for a minute what some people do for an hour daily: adorned ourselves with vests that made our chests, front and back, vibrate. This is how you get mucus out of your airways so that you can breathe. It's not a drug, it's just a motion against the physical barrier to your breaths. It makes your voice shake, and the sound is like a helicopter except you're stuck on ground.

Today we learned a little about the numbers and routine that go into being diabetic. Your meals have to be regular in calorie count and timing, because you can only regulate your sugar with sporadic shots of insulin, not all day long like people with functioning pancreases. For someone who is too careless with ingredients and grew up on sugary snacks, this thought process astounds me. We did a fingerstick glucose on ourselves, which diabetics have to do before every meal and before sleep. It doesn't hurt much, but the moments before you push the button that plunges the needle into your finger (it retracts immediately), caused me some anxiety. I don't like the idea of holding my breath and biting my lip on a regular basis. Based on the number from the fingerstick glucose and the number of calories you consume, you adjust the three daily shots of insulin you need to give yourself. We gave ourselves shots of salt water to simulate what it might be like. As the needle goes in, it doesn't hurt that much, but when pushing the fluid in (an amount of fluid that could be as little as 10% of what a diabetic might require), I cringed. It stung, and it throbbed for awhile afterwards.

Pediatrics is humbling in many ways, when we meet or hear about kids with chronic illnesses, who maintain their right to live their lives through conscious control of the basics, who earn the character of living with more awareness of the fragility of what we do each day.