17 January 2020

"Baby shark, doo doo do do do doo..."

One of the many songs that comes in handy when stuck in the car too long and the 1.5-2-year old is getting restless (at least, this worked great with my niece last time I was in the US). Also one of the many songs enjoyed by 1.5-2-year olds that--should you choose to resort to this method of avoiding toddler meltdown--might get stuck in your head for the rest of the day. Also the song that was going my head the rest of the day after an encounter with a sharp-toothed 4-year old.

"He swallowed a fish bone and his throat hurts. He doesn't want to swallow and keeps crying."

The swallowed-a-fish-bone complaint is very common and often questionable. Fish sauce commonly accompanies the dietary staple here of boule, and fish sauce is full of tiny fish with tinier bones. This means that most people with a sore throat will have swallowed some fish sauce sometime in the past couple of days, so the differential diagnosis remains pretty much the same as any sore throat.

I decided it would be a good idea to get a look at this kid's throat. He seemed to be a pretty cooperative 4-year old, opening his mouth on command, with helpful parents translating to him, not crying at the sight of a Nasara in scrubs. I asked the nursing student for a tongue depressor. None available on the pediatrics ward today.

"Ah, he's trying so well. I can almost see. If I can just press the back of his tongue a little bit . . ." I knew I shouldn't. Any first-year medical student who paid any attention in physical diagnosis (PDX) class could have told me I shouldn't. I pressed my gloved finger gently on the back of his tongue.

*CHOMP*

The tiny baby teeth gripped my left index finger tightly, just behind the distal interphalangeal joint. The parents immediately started yelling at him to open his mouth and stop biting the doctor. This frightened him. He cried as his little jaws just clamped down harder and harder. I finally managed to slide my finger out, but one of his little baby teeth came with it. Blood. His blood, from the loss of the baby tooth that had been imbedded in my finger. I took off my glove. Bleeding inside a little, but the glove itself unbroken.

It turned out he wasn't here for a fish bone. The parents later confessed to the pediatric nurse that they had recently taken him to have his uvula removed, and now they were worried about a possible complication from that operation. Most people here believe that kids should have their uvula removed. One of our OR nurses said that he has been criticized by neighbors in the community because his one-year old still has her uvula. Gotta get that thing out before it causes throat infections, headaches, poor feeding--any common and vaguely understood malady can be blamed on a uvula. Perpetuating uvula lore probably helps keep the village traditional medical practices in business, too. A uvulectomy is a simple surgical procedure they can do on every kid in the village and charge the family for elective surgery.

So Baby Shark's uvula had been removed in the village. He underwent a non-sterile, unnecessary procedure, and now he was here with sore throat and fever and not taking anything by mouth. We admitted him for antibiotics, and I scrounged up a few tongue depressors from the OR stock room to use on the pediatrics service.

This, student doctors, is why you should always use a tongue depressor, even if you're told there are none available and you have to go search the hospital and dig it out of a box in a storage room.

Also, don't let anyone take your uvula.