This past week I had my final exam for my second-to-last block of second year. It’s pretty crazy how fast MS2 has gone by. We got the whole week off to study, so I figured why not shadow in clinic on Monday and in the OR on Friday. It probably wasn’t the best idea considering how much studying I had to this week, but I did well on my exam! And someone in our class aka The Cookie Fairy baked cookies for all of us rising MS3s, it was very sweet.

Before this week I had never actually shadowed during med school. I had actually never shadowed at all, which is weird considering I should have an idea of what specialties I’m interested in since I have to schedule third year electives this month. Oops. Last semester a new discussion-based elective in orthopedic surgery became available. I decided to enroll since taking the elective for two semesters would count as fourth-year elective credit and could mean a week or two off during four-year. I had never thought about ortho before the elective but ended up really enjoying it. My husband is a structural engineer, so he talks to me about random structural elements all the time, like loading, shear walls, concrete, you name it. Surprisingly, it helped me understand a few things in the elective. And even more surprising: I actually enjoyed it. This semester we had a session dedicated to pediatric ortho and I loved it. No matter what specialty I go into, I know it has to involve children since they are my favorite patient population by far.

Monday was clinic day. I arrived early in the morning and clinic started promptly at 9. The staff warned me that it was goingto be a busy day with 20 patients total, but having worked in a derm clinic where we saw 80-100 patients a day I was more than ready. The morning started with more chronic issues like scoliosis follow-ups, hip dysplasia, ACL reconstruction, follow-ups, toe walking, in-toeing, and a club-foot follow up. There were also a few ankle pain visits. Apparently pre-teen girls with ankle pain for a peds orthopedic surgeon is equivalent in frequency to adult lower back pain in an adult clinic. I learned that sometimes the ankle pain will not have any obvious deformity on an xray or manual palpation, and will raise the possibility that the child is somatizing (experiencing psychological distress in the form of physical symptoms). My favorite patient of the morning was a 6-week-old with bilateral clubfoot. Not only was he adorable, but the treatment for clubfoot has lifelong impact. The idea of maintaining function and mobility in children is amazing and I wouldn’t mind doing that the rest of my life.

The afternoon was a fracture clinic. A Monday fracture clinic meant that all the patients would have likely broken something over the weekend and presented to an urgent care or the ED first. After entering the room the temporary cast is removed, the fracture site is palpated to corroborate what the xrays look like (if they bring some with them), then new xrays are taken to make sure proper casting as well as analysis of the break itself. This last step is important because children have active growth plates. If the fracture crosses or comes near the growth plate it is called a Salter-Harris fracture. They occur in 35% of skeletal injuries in children, and are of concern because they can result in premature closure and limb shortening and abnormal growth. As opposed to adults, children heal quite fast. Most of the casts we put on would only stay for 3-4 weeks with a complete recovery. Children are so resilient.

The surgeon I shadowed was extremely welcoming and made sure that I was learning. He was open to and encouraged questions. He also did a wonderful job at establishing rapport. After entering each room, he would address the child first and make them feel like they were in charge, which I think the kids really liked. Most just found it silly. The kids would then feel comfortable enough to tell their story of what happened. The stories were pretty entertaining - a child’s perspective is just so animated and innocent. I was surprised at the variety of cases that peds ortho deals with. They treat musculoskeletal deformities and pathologies secondary to a variety of causes, across a wide age range (infants, children, adolescents, young adults).

I really enjoyed my day at the clinic. I appreciated that most of the problems were solvable and even if surgery was a last resort, there were other less-invasive interventions most of the time. I also liked that the treatment given by an orthopedic surgeon is tangible and life-changing for patients and their families.

Stay tuned for the second part of my shadowing experience - my day in the OR.