Sometimes I feel like being on the pediatric service is pretty boring. That's usually when we either have few patients or when it seems they all have the same few ailments: malaria, pneumonia, diarrhea, jaundice, and so on. At one point last week, though, I stopped and thought of all that had gone on that day and all the difficult and less usual problems our patients that day had. So for the record, here's what I jotted down, just the memorable patients of the day.

In the clinic:

• A one year old weighing 6 kg (13 pounds), and not having HIV
• V, a boy with sickle cell disease whom we've been treating for quite a while for tuberculosis. The TB was unusual in that it infected the bones of his left leg and created abscesses that drained for weeks. It also infected the spine and caused paralysis that is now improving. He came back this week because he was limping. I thought it was because he was having pain but finally got it straight that he wasn't in pain, just limping. Residual weakness? Well, I almost missed it, but I got him on the table and compared his leg lengths: the left was 4 cm shorter than the right! Growth plate damage? Eventually we'll get x-rays but the pre-Christmas rush isn't a good time financially for patients. Fortunately our occupational/physical therapist happened to be in the room at the time and advised us on how to get lifts made for the boy's shoes.
• Grace - see blog. She's doing better at every visit. Starting to use the left hand, obviously attentive to people.
• A newborn complaining of not passing stool for 5 days. Well, ok, the mother was complaining. Exam normal so just reassured.

On the ward:

• A ten year old we thought had typhoid but discovered also has renal failure. Haven't figured this one out yet.
• Two year old with high fever, not responding to anti-malarials. A virus? Typhoid?
• Next to that one, a three year old with high fever, also not responding. Also, he's been having seizures. I point out to the resident & intern the mouth lesions and the subtle seizures he's having just in the hands at the moment. We're worried it may be herpes encephalitis.
• A 2 week old, abandoned by the mother, brought by the orphanage worker with deep jaundice, refusal to suck, and deep, rapid breathing.
• New admission -- 6 month old with pneumonia or sepsis, mother is HIV+. Needs to go to the ICU.
• Newborn recovering from newborn jaundice. Had an exchange blood transfusion for a bilirubin level of 39 mg/dl with symptoms.
• Three babies in the special care nursery. Two are 8 & 9 days old and weigh 750 grams (1 lb 10 oz), the other is a two day old weighing 1.8 kg.
• Finally, in room 9, Mr. Oxygen II ... our growing premie who has been on oxygen for 8 weeks. It's pretty miraculous the way he came through the premie problems and is now growing and looking fine, but he just is taking a long time to get off the oxygen. The new oxygen concentrator has more than paid for itself in the money it has saved for this one patient.

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