Pediatric Medicine Quotes

If the operation is difficult, you are not doing it properly.

Expertise is the mantra of modern medicine. In the early twentieth century, you needed only a high school diploma and a one-year medical degree to practice medicine. By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine.

TOBY CALLED HIS therapist, Carla, whom he’d stopped seeing actively when the apps took over his attention span and his time, but it was August and she was gone to the island where mental health professionals vanished to in the summer. The useless social worker from school was even more useless than usual, camping in the Adirondacks with her family for two weeks. He called mental health services at the hospital but was told that all adolescent and pediatric psychologists were out until September. This is what happened when an entire field of medicine was as disrespected as psychologists. They made their own rules, and one of them was that nobody was allowed to have a breakdown during August, and the other was that this was fucking Europe and they got to take a whole month off from work.

Here are some of the handicaps mutual-fund managers and other professional investors are saddled with: With billions of dollars under management, they must gravitate toward the biggest stocks—the only ones they can buy in the multimillion-dollar quantities they need to fill their portfolios. Thus many funds end up owning the same few overpriced giants. Investors tend to pour more money into funds as the market rises. The managers use that new cash to buy more of the stocks they already own, driving prices to even more dangerous heights. If fund investors ask for their money back when the market drops, the managers may need to sell stocks to cash them out. Just as the funds are forced to buy stocks at inflated prices in a rising market, they become forced sellers as stocks get cheap again. Many portfolio managers get bonuses for beating the market, so they obsessively measure their returns against benchmarks like the S & P 500 index. If a company gets added to an index, hundreds of funds compulsively buy it. (If they don’t, and that stock then does well, the managers look foolish; on the other hand, if they buy it and it does poorly, no one will blame them.) Increasingly, fund managers are expected to specialize. Just as in medicine the general practitioner has given way to the pediatric allergist and the geriatric otolaryngologist, fund managers must buy only “small growth” stocks, or only “mid-sized value” stocks, or nothing but “large blend” stocks.6 If a company gets too big, or too small, or too cheap, or an itty bit too expensive, the fund has to sell it—even if the manager loves the stock. So

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Dr. Lydia Ciarallo in the Department of Pediatrics, Brown University School of Medicine, treated thirty-one asthma patients ages six to eighteen who were deteriorating on conventional treatments. One group was given magnesium sulfate and another group was given saline solution, both intravenously. At fifty minutes the magnesium group had a significantly greater percentage of improvement in lung function, and more magnesium patients than placebo patients were discharged from the emergency department and did not need hospitalization.4 Another study showed a correlation between intracellular magnesium levels and airway spasm. The investigators found that patients who had low cellular magnesium levels had increased bronchial spasm. This finding confirmed not only that magnesium was useful in the treatment of asthma by dilating the bronchial tubes but that lack of magnesium was probably a cause of this condition.5 A team of researchers identified magnesium deficiency as surprisingly common, finding it in 65 percent of an intensive-care population of asthmatics and in 11 percent of an outpatient asthma population. They supported the use of magnesium to help prevent asthma attacks. Magnesium has several antiasthmatic actions. As a calcium antagonist, it relaxes airways and smooth muscles and dilates the lungs. It also reduces airway inflammation, inhibits chemicals that cause spasm, and increases anti-inflammatory substances such as nitric oxide.6 The same study established that a lower dietary magnesium intake was associated with impaired lung function, bronchial hyperreactivity, and an increased risk of wheezing. The study included 2,633 randomly selected adults ages eighteen to seventy. Dietary magnesium intake was calculated by a food frequency questionnaire, and lung function and allergic tendency were evaluated. The investigators concluded that low magnesium intake may be involved in the development of both asthma and chronic obstructive airway disease.

Over the years, I have repeated Eric’s advice to countless people, encouraging them to reduce their career spreadsheets to one column: potential for growth. Of course, not everyone has the opportunity or the desire to work in an industry like high tech. But within any field, there are jobs that have more potential for growth than others. Those in more established industries can look for the rocket ships within their companies—divisions or teams that are expanding. And in careers like teaching or medicine, the corollary is to seek out positions where there is high demand for those skills. For example, in my brother’s field of pediatric neurosurgery, there are some cities with too many physicians, while others have too few. My brother has always elected to work where his expertise would be in demand so he can have the greatest impact. Just

...had recommended pediatrics as the most honest specialization, because children become sick only when in fact they are sick, and they cannot communicate with the physician using conventional words but only with concrete symptoms of real disease. After a certain age, however, adults either had the symptoms without the diseases or, what was worse, serious diseases with the symptoms of minor ones.

In 1983, I moved to San Francisco for my pediatric endocrine fellowship. I had no idea what awaited me in the pediatric ICU: three toddlers, eighteen months old, all on ventilators in congestive heart failure because their parents had placed them on a macrobiotic diet. These ostensibly well-meaning parents were trying to prevent their children from succumbing to the “toxins” associated with meats, oils, and dairy products, so instead they fed their tots grains, cereals, vegetables, and, of course, tater tots. As a result, their hearts ballooned and couldn’t pump from the lack of iron, vitamin D, and calcium.

In 2001, the Institute of Medicine recommended thimerosal’s removal from all pediatric vaccines. In accordance with the IOM recommendation, manufacturers removed thimerosal from childhood vaccines—Hib, hepatitis b, and DTP—except multi-dose flu vaccines in the United States beginning in 2001.

A must-have for any doctor you’re considering for your baby’s care: a residency in pediatrics or family medicine and board certification by either the American Board of Pediatrics (ABP) or the American Board of Family Medicine (ABFM).

In our complex dealing with the physical world, we find it very difficult to recognize all the products of our activities,” literary theorist Raymond Williams wrote in The Country and the City. “We recognize some of the products, and call others by-products; but the slag heap is as real a product as the coal, just as the river stinking with sewage and detergent is as much our product as the reservoir.” Side effects of medicine aren’t side effects, pediatric neurologist Dr. Martha Herbert told us when we interviewed her for Numen. They are just not the effects we want, but that makes them no less important or worthy of our concern. Seeing those effects is simply another way of seeing double.

liked internal medicine and pediatrics, but the physicians I followed warned me that those practices were becoming far less personal—to stay afloat, they had to cram in thirty patients each day. If they were starting out now, a few even said, they might consider another field.

In the past few years he had become conscious of the burden of his own body. He recognized the symptoms. He had read about them in textbooks, he had seen them confirmed in real life, in older patients with no history of serious ailments who suddenly began to describe perfect syndromes that seemed to come straight from medical texts and yet turned out to be imaginary. His professor of children’s clinical medicine at La Salpêtrière had recommended pediatrics as the most honest specialization, because children become sick only when in fact they are sick, and they cannot communicate with the physician using conventional words but only with concrete symptoms of real diseases.

Investors tend to pour more money into funds as the market rises. The managers use that new cash to buy more of the stocks they already own, driving prices to even more dangerous heights. If fund investors ask for their money back when the market drops, the managers may need to sell stocks to cash them out. Just as the funds are forced to buy stocks at inflated prices in a rising market, they become forced sellers as stocks get cheap again. Many portfolio managers get bonuses for beating the market, so they obsessively measure their returns against benchmarks like the S & P 500 index. If a company gets added to an index, hundreds of funds compulsively buy it. (If they don’t, and that stock then does well, the managers look foolish; on the other hand, if they buy it and it does poorly, no one will blame them.) Increasingly, fund managers are expected to specialize. Just as in medicine the general practitioner has given way to the pediatric allergist and the geriatric otolaryngologist, fund managers must buy only “small growth” stocks, or only “mid-sized value” stocks, or nothing but “large blend” stocks.6 If a company gets too big, or too small, or too cheap, or an itty bit too expensive, the fund has to sell it—even if the manager loves the stock. So there’s no reason you can’t

The Baby Hospital forces you to ask the big question. It forces you to ask about Death and heaven and God. “Truly I say to you, whatever you did for one of the least of these brothers and sisters of mine, you did it for Me” (Matthew 25:40).147 Some of the children at the Baby Hospital certainly qualify as the “least of these.” “Let’s not get tired of doing what is good” (Galatians 6:9).148 It’s a privilege to care for children. It’s a privilege to be called during the worst time in a family’s life. It’s a privilege to be entrusted with the life of a baby. It’s a privilege to be expected to study, to overcome the bureaucracy of medicine, and to feel capable of commanding an OR. It’s a privilege to operate on the central nervous system. I can see Death. And I can see Heaven. I wish I could understand the tapestry of the universe, of existence, of nature. But I can’t. But I can see some things. I can see that there is a Song of Creation. I can even hear it. I can hear it in a child’s laugh, my favorite sound. It’s beautiful. Yes. It’s worth it. Because of this:

In Tulsa, Oklahoma, two pediatric nurses—Donna Wong and her colleague, Connie Baker—sought a way of assessing pain in children who had trouble describing what they felt. Wong was incorrectly diagnosed with leukemia as a child, and subjected to painful operations without the aid of analgesics. She became a nurse. In the 1980s, with the smiley face fad in recent memory, the women devised a series of six faces a child could point to. The chart begins with a smiling face and ends with a tearful, grimacing face. The Wong-Baker FACES scale is now a standard in gauging pain in children. There are other versions for adults. Patients are asked to quantify their pain according to a scale—numbered from 0 to 10, 10 being worst. These scales were highly subjective, but they were about the only pain-measurement tools medicine had to offer.

By the century’s end, all doctors had to have a college degree, a four-year medical degree, and an additional three to seven years of residency training in an individual field of practice—pediatrics, surgery, neurology, or the like. In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care.

Solution #1. ELIMINATE PAYOFFS IN CLINICS TO PROMOTE VACCINATIONS. It should be illegal for doctors to accept bonuses or other incentives from insurance or pharmaceutical companies for vaccinating patients. This practice is clearly a conflict of interest. When you take your child to a doctor, you want them to focus on your child and their health, and not on a yearend bonus some other company is paying to push vaccines. These bonuses/kickbacks provide a monetary incentive to the doctor and their office not related to the patient’s health, which is clearly a conflict of interest, and should be illegal. Without this bonus/kickback in their minds, perhaps the doctors can get back in the business of simply taking care of their patients, answering their questions, and providing them with better overall healthcare. If the pediatric office has no money dangling over them in the form of bonuses/kickbacks, then there should be no incentive to bar entrance to any family who wants to receive healthcare, unless the office is so full that they cannot accommodate new patients. This taking away of the bonus/kickback money will remove prejudice and bias against those who do not want to follow the recommended vaccine schedule, or who question the safety of the vaccines. And thereby, all patients will receive equal healthcare service under the law without bias. After all, isn’t this, shouldn’t this be the goal?