No clinda part 2

Yesterday was my first day on the oncology (cancer) ward.  I did pediatric oncology yesterday and today and then I'll do adult oncology for the rest of the week.

The first patient I saw yesterday was an 9 year old girl who had a right above the knee amputation for a rhabdomyosarcoma (cancer of muscle cells).  After the amputation she developed osteomyelitis (infection of the bone) at the site of the amputation and improved on the antibiotic clindamycin, the same antibiotic that was out of stock on Friday when I was on the adult ID ward.  The same shortage of clindamycin hit the pediatric oncology floor and the girl couldn't get her clindamycin doses.  I didn't round on her today to find out if clindamycin was now available or if they had started an alternative antibiotic.  Tomorrow I'm going to get an update.

Today, like yesterday, I rounded on kids with various types of cancer like Hodgkins lymphoma, non-Hodgkins lymphoma, acute lymphoblastic lymphoma etc.  One kid, a 12 year old boy, has refractory Hodgkins lymphoma and needed to have fluid from his chest drained because it had accumulated to the point that it was making it hard for him to breathe.  The general surgeon and a visiting student came to place the chest tube early in the afternoon.  Curtains were placed around the bed so that they blocked the view from the foot of the bed but kids and parents in the same row as out patient had a front and center view.  Outside the window, people were having lunch and occasionally looked in to see the procedure.  While the people outside seemed generally unflustered by the boy's screams, some of the kids inside looked pretty uncomfortable to horrified.

During the procedure, the mother of the boy sat at the foot of the bed, trying to comfort her son.  Aside from screaming during the entire procedure, he bravely kept his body steady, not once flinching at the pain.  Once the tube was placed, the surgery resident realized that he had forgotten a suture to tie the tube to the chest wall to keep it from slipping out.  One person went looking for a suture in the building and I went to try to find some in the orthopedic surgery ward.  After walking to a few buildings in the general vicinity of where I was told the orthopedic department is located, I found someone to help me.  Unfortunately, the person who had the key to get into the area where the sutures are stored had gone home for the day and the only suture available otherwise was the wrong kind.  So I walked back to the pediatric oncology ward, the boys screams leading me in the right direction, hoping that someone else had found the right suture.  Fortunately I found the surgeon in the process of tying the tube in place, even if it was resorbable (wrong kind) of suture.