Rocket Fuel

Its nice to finally have a day off after working two weeks in a row. Friday was the last day of my rotation in pediatric cardiology. It started out early, as have most days for the past two weeks. I was up at 4am and at the hospital by 5:10am. By 6:45am, I had seen all my patients, written my notes, and by 7am I was ready to observe a 5-6 hour surgery. One of my patients had a congenital atrioventricular septal defect which was going to require surgical repair. I have never seen so much work go into preparing an operating room, and I can only imagine the cost of the equipment and the surgery. I watched them set up the equipment for almost an hour before word came that the surgery had been cancelled. Over the past two weeks I have seen a good chunk of pediatric cardiology. In first and second year we studied all sorts of cardiac defects and now I finally had a chance to see them. I know I saw tetralogy of fallot, transposition of the great arteries, atrial and ventricular septal defects, coarctation of the aorta, and patent ductus arteriosis just to name a few. Some of these kids have to be fed "rocket fuel." With the various heart defects, their circulatory systems are incredible inefficient and they require a huge amount of calories. Some of them were on 140-160kcal/kg/day diets via feeding tubes. If I remember correctly, 1kcal=1Calorie used on regular food labels. If there is a dietician out there they can recheck my work, but I think that would come out to about 68 Calories/lbs/day. In other words, for every pound you weigh, you must consume 68 Calories a day. Plug in your weight and you can figure out how many calories total you would need a day. Granted, I think infants need more calories for their weight, but these kids are requiring huge amounts of calories. Even on these diets, we aren't always able to get them to grow as needed. On top of all this, some of these kids have congestive heart failure and require fluid restricted diets so their lungs don't get too congested. It is a real challenge to pack enough fuel into such a limited volume feed. Afternoons were always fun. We would usually meet up some time after lunch to do "murmur rounds." We would get a chance to go around and see patients with different kinds of heart murmurs. We would all get a chance to listen, describe what we heard, and the go through the process with our attending physician of figuring out what the possible causes might be. It was amazing to see how a well trained ear could get a pretty good idea of what wall, valve, or vessel had the problem. If I learned anything else, it was that kids are incredibly resilient. These kids would go in for open heart surgery. The surgeons would crack open the sternum, go in and do some major repair and these kids would be going home a few days later. Their pain tolerence was also pretty amazing. Who knows if I would ever end up in pediatric cardiology, but it certainly was an interesting two weeks.