Despite having lived in Africa, My PPD turned positive in med school. BUT I DON'T HAVE TB! Whew.

Recently I had my annual PPD test placed. The area became red and irritated, as always occurs for me, but then something truly horrible happened - it became raised. Not much, but there was a definite bump under my skin. I went in to have it read and to my utter horror it was read as positive. I was justly upset at the possibility of having tuberculosis and had much to ponder as I waited for my chest xray. It just seemed so ironic to me that despite having lived for a total of a year in Africa, that my PPD test would turn positive during the third year of medical school! I had not 1, but 2, negative PPD tests since returning from last adventure in Africa, so it would have to mean that got infected during med school. Still fuming at my bad luck, I went with much indignation to my TB treatment program visit. There I was offered a blood test to confirm that I actually did have TB before I had to take 9 months of a slightly nasty drug called INH (isoniazid). I got the quantiferon TB test, and it turned out to be negative. Today I got the bill for the test: $102.84. I wonder if that goes in the miscellaneous column of my medical education expenses.



A map of TB prevalence by country. Notice that the East African countries I have worked in have a MUCH higher rate of TB prevalence than the US. Good times.



A positive PPD test. This is not a picture of my arm (image from google image search), but the raised area is similar to what I experienced.

Temporary tattoos and teddy bears named 'teddy bear'

On my pediatrics rotation I got to take care of some of the cutest kids. When I say cute, I mean cute. Some of these kids were so adorable, they put the Welches Grapefruit juice commercial kids to shame. One three year old girl had bright eyes, thick black hair and cute dimples when she smiled. When I went in to listen to her lungs, I found her carefully clutching a little Teddy Bear. She seemed shy, but also happy to interact despite being on oxygen. I tried to strike up a conversation by asking, "That's a nice Teddy Bear you have there. What is his name?" My 3 year old patient responded with a look that clearly indicated she thought I was a little bit stupid and said, "Teddy Bear." The little girl's mom smiled and said, "Yeah, we are going through a real creative period right now."

A couple days later I came in to check on this same patient. I asked my three year old patient, "How are you today?" She responded in very cute high squeaky voice: "Bedder." She was so cute I tried to go through the process of getting a picture taken with her to share (this involves a signed consent from mom as well as some other paperwork), but my patient improved so much that she was discharged the same day so I didn't get a chance to do the photo shoot.

A few weeks later I had a 4 year old patient who was very sick and hated being examined, taking her medications and getting nebulizer treatments. However, this patient absolutely loved temporary tattoos. So her parents had a very sizable selection of temporary girly tattoos (pink flowers, stars, happy animals, etc) that she could pick from after cooperating with a medical exam or treatment. It worked really well. After a couple days, I guess she started to like me because after I examined her in the morning, she asked her dad to show her the tattoo collection and picked one out just for me. (If you are wonder, yes, this was a highlight of my pediatrics rotation). I walked around the rest of the day as the proud owner of a pink flowers and stars temporary tattoo. The tattoo was cute on the peds floor, but it got some strange looks outside the hospital!

This is just a sampling of some of the cute-kid interactions I had.

The upside of having a family that is a festering cesspool of viral illness

I always get sick when I go home and visit my family. Always! In the past I have found it very irritating. You have a free weekend a couple weeks before finals and go up to see the fam. You arrive and an adoring sister with copious nasal discharge gives you a huge hug and proceeds to use your jacket as a make-shift kleenex for her nose. 3 days later you go back to your house in Seattle, develop a sore throat, runny nose and a fever and you realize you have killer viral illness #8 of the season. 10 days later you feel better, but not before giving said killer viral illness to several classmates, undoubtedly resulting in the loss of a couple friendships. A couple months later, all is forgotten and you go home to visit the family again, only to have the process repeated.

HOWEVER, on my peds rotation it came in handy. And when I say handy, I mean really handy. The other medical student on my pediatrics rotation fell seriously ill, not once but twice. He developed a high fever resulting in the inability to get out of bed for several days, and actual hallucinations. During this time I also developed a little bit of a scratchy throat for a day or two which quickly resolved. It seemed like my body was fighting off a lesser version of something awful it had encountered before. (I don't mean to imply that I have a killer immune system or that I never get sick. I actually get sick a lot, it is just that pediatrics clinic can't hold a candle to the immune challenge you get from hangin' with a family that has 13 kids).

Apparently, it is very common for medical students to fall very ill during their pediatrics rotation. We were warned about this, and staff commented that the acquiring of severe illness from peds clinic seems to occur more often with people who are only children growing up or had fairly clean living environments. Well, not a problem here! :)
Here my (fun and terrific) family has been labeled by name. However, perhaps the could also each be labeled as "Immune challenge #1," "Immune challenge #2," etc.