Many paediatricians have always known that they wanted to be paediatricians, but my case was different. Paediatrics was not my career choice in medical school; rather it was obstetrics and gynaecology even though my best scores were in paediatrics. I had one or two inspirational role model consultants and teachers in obstetrics and gynaecology who sparked a love for the subject and as such, most of us at that time in medical school wanted a future career in that field. Little did I know that my future would be in paediatrics and I would love it much more than any other specialty. I have never regretted the day that I accepted paediatrics training.
Most importantly, it was watching the beaming smiles that we put on parents' faces that attracted me to [neonatology]
When I started paediatrics training, I knew almost immediately that I wanted to be a neonatologist. It was the mixture of opportunities to perform procedural skills, managing premature babies, seeing them growing up into infants and appreciating our teams’ efforts. Most importantly, it was watching the beaming smiles that we put on parents' faces that attracted me to this sub-specialty. Even though it has its challenges, the successes that we pull through tend to outweigh the difficulties that we encounter.
I am proud to be a paediatrician, but I owe my experiences to my patients and their families. They have shaped me as a paediatrician and over the years a few of these cases have stayed with me. I would like to take a trip down memory lane to a case in general paediatrics that stood out.
That morning, many years ago, I was a registrar ST4 at a district general hospital. I received a referral call from an A&E nurse to see a 3-month-old twin baby boy*. I informed the nurse that I would see him immediately after I finish reviewing another patient on the ward. A few minutes later, the nurse phoned again and this time, she said, “Uche, please can you come and see this baby urgently. All the observations are normal but there is something off about the baby.”
I am proud to be a paediatrician, but I owe my experiences to my patients and their families.
I immediately handed over the patient that I was reviewing to another registrar and left to see this baby. When I arrived at A&E, he looked pale in comparison to his twin sister. The parents confirmed that he was previously as pink as his sister. I initially sat down to take the history but immediately stood up after making a swift decision to move him to the resuscitation bay. My impression then was that he was septic based on fact that he was quiet, looked unwell and pale. We stayed at the resuscitation bay from that morning to late evening until the transport team arrived and transported him out of our hospital to a paediatric intensive care unit.
He turned out to be a case of shaken baby (non-accidental injury). He was pale because he was anaemic and had bled into his brain. The last time I saw him, he had a distinct high-pitched cry, not fixing and following, and a prognosis of severe neurodisability. A few years later, I was summoned to the family court, then criminal courts to give evidence regarding this case.
...this case illustrated the importance of teamwork, collaborating and trusting our colleagues.
This case has stayed with me over the years for a few reasons. First, I was glad that our team did not miss a case of non-accidental injury. As paediatricians, we know that it may occasionally be difficult to make that diagnosis because it is not always so straightforward. Secondly, this case illustrated the importance of teamwork, collaborating and trusting our colleagues. It was a good pick up by the nurse who trusted her clinical assessment and escalated her concerns appropriately. Her concern and the baby’s pale look in comparison to his twin sister made me transfer the baby to the resuscitation bay.
Finally, this case emphasises the importance of good documentation. I had stared at my detailed documentation several years after the incident at the courts and this enabled me to give good evidence.
Dr Uche Ogunna is a consultant neonatologist at Whittington Hospital, London.
- *. Names and other information that could identify someone have been changed.