Signout is hospital slang for the transfer of information between patient care teams. It is also the name of this blog, which represents one of the less dysfunctional ways in which Dr. Signout copes with her participation in a U.S. medical residency program.
There's a 3-year old kid on our pediatric hematology-oncology service who has a high-risk, stage IV, disseminated neuroblastoma: a bad cancer with a terrible prognosis. The mass in his liver is huge, and distends his abdomen way out of proportion to his limbs. He is otherwise a truly beautiful child, with big, blue eyes and an open, winning smile.
I went in last night at about 3 a.m. to examine him because he had spiked a fever. When I laid my hand flat on his belly, he opened his eyes and said, in full voice, "Don't hurt me!"
In my training, I do both adult and pediatric medicine. However, although I've been on pediatric rotations for months now, it's the nature of my program that I spend very little time actually talking to and examining my pediatric patients. It's possible that I know less about what kids are like now than I did before I started my intern year.
Perhaps that's why I was stunned to hear him tell me not to hurt him. Adults rarely use those words--they usually just cringe, or make a grim face, or sit quietly. Perhaps they've lost the sense that they have a right to be comfortable.
This is developmentally appropriate, on some level: understanding that some unpleasant things are good for you and must be tolerated is a part of maturity. I only hope that it is maturity and not a sense of powerlessness that causes so many adults to remain silent when they anticipate pain.
In my overnight call-addled state, it seems like a good idea to try to hear this boy's voice every time I go in to see a patient--perhaps especially when I return to adult medicine, which I do in two weeks.
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