Rotation #2 Lucile Packard Children's Hospital

Lucile Packard's Children's Hospital at Stanford University is unlike any other hospital I've ever been to. It's perhaps one of the craziest tertiary care centers in the world. During the time I'm spending here, I'm doing a Pediatrics Nephrology Rotation. What's different about this rotation for me, is that I interact mostly with fellows and Attendings instead of residents...and to some degree, this is what makes the rotation a bit harder for me. Fellows are two steps away from medical students and Attendings are three steps away. I'm used to helping residents out or even sometimes acting like an intern. Fellows though, have already completed their residency years and are now going on to subspecialize in their fields. In short, there's not much that I can do to help a fellow out and I certainly can't act like a fellow if I haven't made it to residency yet.

Nephrology is a crazy field. Pediatrics Nephrology is even crazier. You get to deal with all the congenital kidney anomalies that occur in utero (while the baby is still developing in the mom's uterus) or other kidney concerns that arise when the kidneys take a hit from difficulties during delivery or as the baby is growing older. One of the main problems that lead to the kidneys taking a hit is when there is severe blood loss, or hemorrhage. Examples: a placental abruption during delivery where the placenta suddenly breaks away from the uterus. When this happens, suddenly you lose the blood exchange that's supposed to be carrying mom's fresh blood which contains oxygen and nutrients to the baby. In addition, now you're also unable to return blood that contains waste metabolites from the baby back to mom for filtering. The placenta abruption can further cause hemorrhaging in both the mom and the baby. In an effort to preserve blood flow to the two vital organs of the body, the brain and the heart, the body naturally shunts blood away from other organs such as the GI tract, your extremities, or the kidneys. The result is that even if the baby's kidneys developed normally, a sudden traumatic event can cause life-changing consequences. 

                                    

A good majority of the Pediatric Nephrology patients at LPCH are incredibly complex. Not only do we see kids with kidney problems, we also seem to see a ton of kids with kidney and GI problems. A large part of this is that kidney issues cause a variety of other problems including but not limited to  electrolyte imbalances, feeding issues, blood pressure changes, and the most basic growing concerns. At best, the kids get a kidney transplant and hopefully live another 10 to 20 years, at worst, they pass away before a donor kidney becomes available. It's entirely a giant spiral downwards which rarely ends well.

LPCH is also the first hospital that I've visited where several of the subspecialty services have their own ward patients in addition to consult patients. From what I've seen so far, it makes on-service weeks incredibly tiring, having to be the point team in charge of your own ward patients as well as having to round on consult service patients every day. It's so miraculous that the fellows and Attendings are able to keep up with all the patients and keep the events of the day straight. Just five days of service is enough to make anyone completely exhausted!

On my last two inpatient weeks I've seen incredible medicine taking place. Events are happening inside Lucile Packard's that simply does not occur anywhere else in the world, including other top Children's Hospitals in the United States. I have two more weeks of Pediatrics Nephrology which I'll be finishing off in outpatient clinic and I hope I'm able to learn a little bit more on my next two weeks here.