“I ate the purple ones”
Thursday, October 1st, 2009My 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!)
