Our pediatrician has left the premises. Her tour has ended, and leadership has decided not to replace her with another pediatrician. In fact, this decision was made in haste last week, and the pediatrician previously planning on coming over was told to unpack his bags, as he was staying stateside. As our troops and the contractors are big people, the decision to send home the keeper of the little people seemed prudent.
Then there is the matter of goodwill. Or, rather, the political capital our military may aim to gain by providing care to the surrounding community, which, as one may gather, includes children. Children in auto accidents, children burned in fires, children with risk to life, limb or eyesight. Now, there are not many children who find their way into our hospital, but there are some, and typically, these are burn victims who end up on service for months at a time. Luckily, the surgeons known how to care for burns in children. The problem is these patients get infections, and develop acute medical issues. And who is to care for this? Not the surgeons. Children receive medicine in weight-based formulas. They do not suffer from diseases of wear - coronary disease, emphysema, diabetes (at least adult-onset diabetes) - but, their physiology and psychology are just different. Metabolism. Growth plates. Communication. Fear. Together, we are a team of "adult doctors" who will care for these children who have no pediatrician.
George Annas recently wrote an article in the New England Journal of Medicine concluding, "...the medical standard of care... ...can be understood as doing what you can under the circumstances, with the patient's informed consent. The standard of care is the same in sickness and in health and in emergencies." I would like to think that taking care of children in this setting is doing just that: making lemonade.
The impossibility that has been reckoned on physicians in this situation, however, in which mutually exclusive sentiments are pursued - operating a Level I trauma center, and maintaining the 'status' of this capability, while simultaneously trimming down essential personnel from the roster - is the heart of the frustration. Meet irrational demands to do the impossible. This is a recurring theme in the military which I will be quite glad to leave behind.
Pediatrics is a separate residency training I gladly avoided for a reason. Now that we have sick children here, I will do my best to care for them, and will in the future when they come in to the hospital - I will make chicken salad. That does not mean, however, that I approve of another chicken shit policy.