“I ate the purple ones”
My four weeks in the Pediatric Intensive Care Unit flew by, and once again I find myself on a new rotation. I had an amazing time in the PICU at Toledo Children’s, so I’m a bit bummed to be leaving. This month I am doing pediatric GI, working mainly in outpatient clinics.
One big difference about working in the outpatient setting is that I won’t be on-call. I definitely enjoyed taking call, despite the havoc it sometimes wreaked on my sleep cycle. It seems that my best “lightbulb” learning moments and most interesting patients from my clinical rotations have always came in the middle of the night. The hospital is definitely a different world after dark. The wards seem deserted and are eerily quiet. My fellow acting intern Dusty and I were on-call together a few nights. It was cool to be able to bounce ideas off one another regarding our patients or partake in the cafeteria’s amazing late-night taco bar.
Almost every night I took call the unit received a patient with a familiar story. While in high school, I remember helping to fill up my grandmother’s pill containers each week. It had seven compartments marked Sunday through Saturday to help her keep track of her medicines. While this is a great organizing tool, there were quite a few nights when I saw the potentially devastating effects when children got ahold of them. We saw little guys admitted for suspected drug overdoses, and their stories were similar. A parent walked back into a room to find a chair pushed over to the kitchen counter, half-empty bottles of medication on the floor, or a child who simply said “I ate the purple ones”.
The thought of two-year-olds consuming large amounts of multiple medicines is certainly a scary one. However, strictly from an academic standpoint, working up patients for drug overdoses is pretty interesting. The pills in question treated some of the most common “American” medical problems (pain, hypertension, diabetes, anxiety). Each one tweaked the body’s physiology to provide its effect. When evaluating an overdose you have to look at each medicine and understand how it works. What is the mechanism of action? What is the drug’s half-life? (aka how long will the drug be in the body?) What organ systems will be affected by toxicity, and how should we monitor for adverse effects? These impromptu pharmacology reviews were really important to deciding a plan of care. I made plenty of late-night calls to poison control to ensure that we were covering all our bases.
Luckily the kids I saw those nights had good outcomes. Most of them stayed in the unit for observation and were sent home the next day. With these cases I saw firsthand the importance of keeping medicines and other chemicals locked and stowed away from kids. The average family medicine cabinet can provide remedies to almost every illness under the sun. For little guys this stockpile might look like a colorful mix of Jelly Belly’s, but accidental overdoses can have disastrous consequences (not to mention the purple ones don’t taste like grape!)
October 2nd, 2009at 12:48 am
I enjoy reading your blogs
October 2nd, 2009at 9:09 am
Multicolored tablets are good for differentiating between different meds and good for branding, but as you’ve seen, they look like candy to children. They need uglier pills.
October 2nd, 2009at 12:20 pm
I enjoy reading your journal . Thanks for taking the time to write.
October 2nd, 2009at 1:09 pm
Your blog is great. I remember when my son climbed up and took the cough syrup out of the cupboard (he is now 30+) and drank 1/2 the bottle. That was scary. I thought those days were over, but now my cat goes after my pills if I put them on the counter to get a drink.
October 2nd, 2009at 1:28 pm
I can’t believe it’s been four months since you started in PICU. Keep writing your blogs, Patrick. They are fascinating!
October 5th, 2009at 10:53 am
It seems like yesterday when we were sitting in Linda’s English class in the Honors Program! Very thoughtful blogs- glad to see life is going well for you!
Duane H
October 5th, 2009at 11:04 am
I’ve been reading your blogs for months now, and you are an amazing writer. I look forward to your posts and always look forward to the next post. Your writing shows such compassion and empathy. I think you will make an exceptional Pediatric Physician!