by Steven D. Blatt, MD
Since its opening in February 2012, other members of my department and I have been working at Upstate Golisano After Hours Care at Community Campus. I have a daytime job at Upstate University and Pediatric Adolescent Center, so why do I often work nights at After Hours, especially when I do not get home until midnight? The main reason I work there is because I love the work. I thought you might be interested in some of the types of cases I see.
A mother brought in her 18 month old who seems to have a painful right arm. The child was fine in the morning but complained of arm pain in the afternoon. The child is active and healthy without any medical problems. I suspected “Nursemaid’s Elbow” which is a surprisingly common condition. It results from someone, once upon a time, the “Nursemaid”, abruptly pulling on the child’s hand. For example, a toddler may start to run into traffic and the parent may pull him back onto the sidewalk, averting a terrible accident. Every so often, this results in dislocation of the elbow. Once I suspected this, it’s easy to maneuver the elbow back into its proper position. Within minutes, the child feels better and the parent is relieved. Best of all, we don’t need an x-ray. It’s the definition of instant gratification for the patient, the parent, and the doctor.
A common case is the child with a laceration. Many of us, including me, love procedures. It shouldn’t be surprising that many doctors enjoy “fixing things with their hands.” Under the best circumstances, we can apply a topical anesthetic, clean out the wound with water sprayed from a syringe, and use glue to close the wound. The glue is medical grade super glue. I hold the edges of the wound together for 10 seconds and the glue dries. That’s all. No needles. No pain. The glue will fall off on its own. And the cosmetic result is as good as suturing. There are many times when gluing is not feasible, so we must use suturing.
A mainstay of my work at After Hours is taking care of ill patients. I know it’s not fun to be a sick kid and it’s even worse to be the parent of a sick kid. However, it is gratifying to be the doctor or the nurse caring for an ill child. Sometimes, we can pinpoint the cause to something treatable, such as pneumonia, strep throat, asthma, or an ear infection. This is usually a great situation: we know the cause and know how to treat it.
There are many times when we can figure out the cause, but we don’t have any cures. The most common example of this is a virus. The 3 year old with a cough and fever will often have a virus. We don’t have many medicines available to cure these types of illnesses, but can offer some advice to make the child feel a little better. Honey for the cough; there is scientific evidence to support this. Fluids, yes, chicken soup is good to take. Rest is always good. Also, remember to get your flu shot…it’s not too late! Even though I often feel badly because I can’t always offer curative treatments, parents usually tell me that as long as they know the virus will resolve on its own, they are relieved. Many parents just want to make sure nothing bad will happen or they aren’t missing anything. After 30 years of being a pediatrician, I sometimes forget that reassuring words from a physician can go a long way to relieve a patient’s or parent’s anxiety.
I enjoy working at After Hours. The cases are varied and interesting. I usually find them fun, well, fun if you are a doctor! It’s always great to work with kids and to reassure their parents. Nothing is better for a doctor than making their patient feel better and no doctor is luckier than the doctor who takes care of children. That’s what gets me through those late nights….and gets me up the next morning so I’m not late for my day job.