Squeezed between intense study sessions, the very best part of my medical education continues to be the clinical hours spent learning and doing in the Emergency Department. Its not the adrenaline thing, although some folks insist that’s why I love ER. But what I truly embrace about it is the unpredictability, the chance to see something new constantly.
Last night was no different.
We were a little busy. Soon after my shift began, both docs suggested I go do an exam in Room Two where there was a baby brought in for “possible bruising”.
My heart beat faster – after all, its not often they send me in alone first and tell me to practice doing a full exam. At the same time, I was a little worried. Without even seeing the patient, my mind immediately skipped to possible abuse issues, playing through scenarios in my head and wondering why the docs chose this particular patient for me.
Determined to practice compassion while doing a thorough exam, I knocked on the door and introduced myself.
Hi, I’m Student Doctor J, I’ll be doing an exam and then my supervisor will need to come see you as well. So tell me what brings you in tonight…
Baby was dressed in just a diaper as dad tried to explain to me how he had been born with a little mark on his back, but it continued to spread. Now the marks covered baby’s back and went across both shoulders. Not a rash, not the sort of bruises I’d ever seen before. But marks that were kinda bluish. I continued to examine baby hoping I wasn’t missing something, and more convinced as I went along that this really wasn’t bruises and we didn’t need to be concerned about abuse.
I’d never seen anything like it.
Thorough exam complete on an otherwise healthy baby boy, and after learning that dad really wanted some simple blood test to tell him what this was and if his child would be okay, I went back to report what I knew.
Which wasn’t much. Often, when I see something for the first time, I feel completely tongue-tied trying to explain it and last night was no different. Then my attending and I got to do a little research to figure out what this was as he didn’t immediately know either (which perversely made me feel a little better).
Aha! Now I know what congenital dermal melanocytosis looks like! More prevalent among those from Asian (this baby) and African American decent, its an issue where melanocytes are trapped in the lower part of the dermal layer during embryonic development. Its harmless, and most often completely resolves by 3-5 years. And even if the marks remain throughout life, there’s no report of any adverse affect. Parents can be understandably worried when they see those funny looking blue marks, but clinicians need to be aware of the condition in order to avoid concerns about abuse.
Last night, between the inevitable colds and chest pain and panic attacks, I learned about a new condition that I’ll now always remember. And that little bit of researching and reassuring reminded me once again why I positively love medicine in general, and the ER in particular.
Now back to the books; its a Review day, and I’m getting an early start with the endless q-bank questions about glycogen storage diseases, pharm basics, and opportunistic infections. And I’m finding the joy in Review that comes from realizing I actually do remember details of what I first learned many months ago!