At Children's Hospital, the doctors in specialty training are called residents. What are they like? Why have they chosen to work with chilren? My associate, Annie Koch, spent some time last month with a senior Children's resident to find out. Her report:
The phone rings one late December afternoon in the fourth-floor office of Dr. Fred Tecklenburg, a chief resident at Children's Hospital. Tecklenburg is informed that a 7-year-old boy he admitted earlier in the day is about to have an echocardiogram to check for damage to the heart. He hangs up the phone and heads for the cardiology department.
The boy was sent to Children's after an X-ray revealed that he had an enlarged heart. For the past couple of weeks, the boy has been complaining of chest pains and experiencing bouts of fever at night.
Tecklenburg joins a group of doctors and nurses already at the boy's bedside. He speaks to the medical staff and takes a look at the echocardiogram, a moving picture of the boy's heart. He examined the boy when he first arrived at the hospital, and has dropped by because he is responsible for keeping up with the boy's progress.
Admitting patients to the hospital and keeping abreast of their conditions is one of Fred Tecklenburg's main responsibilities. He is one of three residents chosen to stay on for a fourth year as a chief resident.
He is a doctor to such children as the 7-year-old with the heart problem; he is an informal adviser to the 66 first-, second- and third-year residents at the hospital and he is an aide to and protege of Dr. Arnold Einhorn, chairman of pediatric medicine.
Tecklenburg is also a husband and a father of two. An energetic, boyish 30-year-old, he attended Georgetown University and the Medical University of South Carolina in Charleston. He originally intended to specialize in family practice, but decided near the close of medical school to go into pediatrics.
Because dozens of subspecialties have been developed within pediatrics, Tecklenburg thinks it's an exciting field. He believes that while much of adult sickness is either psychosomatic or self-inflicted, most children's diseases are beyond the control of the victims. This, Tecklenburg believes, "makes it more compelling to treat kids and see them cured."
Tecklenburg says he investigated about 10 institutions while he was trying to decide where to do his residency, which is the hospital training a doctor undergoes after medical school. Two factors contributed to his decision to choose Children's.
He believes it makes "all the difference in the world" for a pediatrician to do his residency at a hospital such as Children's, where all the resources are geared toward treatment of children. He also liked the staff at Children's. "The real drawing card here would be the people," he says.
Tecklenburg admits that medical training (four years of medical school, then usually at least three years of residency) is difficult. He says that once he got to medical school, he was somewhat overwhelmed with "so much incredible material to learn." He says he came "to the realization that, my God, it's not that easy to shine around here."
As a beginning medical student, he remembers overidentifying with his patients, and feeling aware of his own physical vulnerability. Later, he became so used to seeing sickness that, by his own description, he became slightly "dehumanized." Finally, he learned to look at a patient's illness with what he calls a kind of "detached concern."
Tecklenburg admits that in medical school, he thought that "medicine is a god." But when he became a first-year resident (or intern) at Children's, he began to realize that "there are often no absolute rights or wrongs" in dealing with disease.
Tecklenburg believes that a medical school graduate doesn't really begin to feel like a doctor until the first year of residency. This is the first time he is given primary responsibility for his patients. The hours are long and exhausting (sometimes interns are awake for 36 hours at a time) and the combination of being exposed to sickness and being fatigued can make an intern ill himself.
During his first year, Tecklenburg says he was ill several times and fainted once in the nursery after being awake all day and all night for five days out of 10.
Although Tecklenburg admits that "residency is no fun," he believes that the attending physicians (rotating pediatricians and sub-specialists) at Children's make it their business to keep residencies as pleasant and rewarding as possible.
Almost all attendings physicians are on a first-name basis with residents and are easily accessible for advice, Tecklenburg says. The teaching atmosphere, he says, is informal and friendly.
During his second year of residency, Tecklenburg was chosen by other residents and Dr. Einhorn to stay on as a $25,000-a-year chief resident.
He and the two other fourth-year residents, Drs. Rebecca Ichord and William Lewander, take turns admitting patients to the hospital, overseeing emergency-room activity and arranging conferences for other residents.
Tecklenburg says he has enjoyed the extra year at the hospital. He believes that because Children's is both a primary-care center and a referral center with a national reputation, it attracts the finest doctors in the country and some of the most unusual medical cases.
"The feeling here is one of vibrant growth," he says. "It's always exciting. There's always a new illness we haven't seen before."
As a doctor, Tecklenburg feels that "it's an incredible honor to be allowed to take care of people when they're in dire straits." As a pediatrician, he does not expect children to cooperate all the time. And as a parent, he understands that a lot of kids get sick in the middle of the night. He says he can easily empathize with an anxious parent because he knows from experience that "it's not easy" to be the parent of a sick child.
Tecklenburg will finish up at Children's this summer. He has accepted a two-year fellowship in emergency pediatrics at Children's Hospital of Philadelphia. After finishing that, he hopes to return to South Carolina as an attending physician in the emergency department of a pediatric hospital.
He is "looking forward to seeing how medicine is practiced elsewhere." But he says that it will be hard to leave Children's.
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Make a check or money order payable to Children's Hospital and mail it to Bob Levey, The Washington Post, Washington, D.C. 20071.