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  • Writer's pictureVincent Chuah


Updated: Apr 23

#This is an old post in 2017 from the blog Standing Alone

Entering pediatric as the last posting was incredibly tiring. Why? Because dealing with infants and kids requires a tremendous amount of energy, careful observation, and prompt management.

Ohh...babies are so cute. Ohh... babies are so adorable. That's all just bullsh*t until you experience the true hectic nature of a pediatric posting. Without further ado, let me introduce you to this overwhelming mix of cuteness, stress, tiredness, and anger.

The pediatric posting in HSIJB is divided into two parts:

1) NICU (neonatal intensive care unit)

2) Pediatric wards

You have to spend two months in each unit. I was rotated to the pediatric ward first. To pass the pediatric posting, you need to excel in NRP (neonatal resuscitation). In the pediatric ward, you have to deal with children aged between one month and twelve years old, along with their parents. It's a challenging task as children tend to cry...and not just a little bit, but A LOT!

They cry to express everything!!! It's truly speechless:

- They cry when they meet strangers

- They cry during blood taking

- They cry during branula insertion

- They cry during nebulization

- They even cry when taking medication

Basically, it's difficult to handle them. And most of the time, parents become anxious when their child is sick. You have to face anxious and difficult parents, and you never truly understand how challenging it is until you experience it yourself.

You have to perform branula insertion or blood taking for these young patients. You learn and practice the proverb "united we stand." Children tend to struggle, and their common reflex is withdrawal. Therefore, you need a few more people to help restrain the children while performing these procedures. It's nearly impossible to perform blood taking alone in pediatric patients unless they are mature enough.

What if you fail at blood taking or branula insertion? Luckily, the nurses in the pediatric ward are nice. They have a lot of experience and are kind enough to help you. But most of the time, you have to try it yourself before asking for help. If they fail, you need to call the MOs. But you don't want to trouble your MOs too much, as they might question your competence. Practice makes perfect!

There is a ward called the pediatric oncology ward/nephro ward. It's an incredibly stressful area. You are dealing with oncology patients (those with leukemia/carcinoma) who are admitted for chemotherapy, neutropenia sepsis, disease flares, or newly diagnosed cases. They are fragile, long-term patients who have experienced multiple scary procedures such as lumbar punctures, chemoport insertions, and frequent blood taking. You can never truly understand what they have gone through. Due to these reasons, it's really tough to work here. The workload is heavy, detailed documentation is required, but fortunately, the specialists are super nice.

Next is the NICU rotation. During this rotation, you learn how to resuscitate newborns. First, you need to study NRP (neonatal resuscitation) well. You must pass the NRP course during this rotation, and you will be assigned one MO/specialist to guide you through it. You will be divided into small groups of four or five, and you should actively request teaching from the assigned MO. Your achievement depends on your effort.

Once you have a good grasp of NRP, you'll find that resuscitating a newborn becomes easier and more understandable. In cases of emergency C-sections, your MO will ask you to attend the resuscitation, depending on the neonate's condition. If there is thick liquor, your MO will accompany

you during resuscitation as the risk of intubation is higher. If it's a milder condition, you'll attend the resuscitation alone.

Of course, your MO is inclined to assign those who have higher competence and knowledge in newborn resuscitation. It's a form of reassurance, as they believe you can handle the resuscitation well. Those with poor knowledge and a poor attitude won't be given many chances until they improve themselves.

One downside is that if you attend a resuscitation and believe the baby requires ICU admission due to tachypnea (TTN) or any other reason, but by the time the baby arrives at the NICU, they are no longer tachypneic, you may face scolding or sarcasm from the nurses. It's part and parcel of life in the NICU.

Overall, the NICU rotation primarily deals with preterm babies, severe jaundice cases, septic babies, and ill babies. Most of the time, you need to assist your MO. The nurses in the NICU are competent but can be fierce at times. You need to get along well with them by offering help. I enjoyed this posting, except for dealing with crying babies and the difficulty in obtaining IV access for toddlers.

I believe you will enjoy it too.

Still, things may have changed. Be positive. Life is fantasy.

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