Hi All! I’m Iréal Fusco, a pediatric resident training at Nicklaus Children’s Hospital in Miami. I’ve been very excited about participating in the Issa Trust Pediatric rotation as a way to expand my Pediatric training.

My first day was this last Friday, March 10th, 2017 at the A&E in Port Antonio. It was a long drive to the location but there was gorgeous scenery along the way. Mr. Campbell is an administrator at the hospital. He picked me up and drove me to the hospital himself!



Once there, I felt a bit like an intern all over again starting at a new place. I was thrown right in seeing patients so I had to learn how the system worked as I worked. The overall pathology was similar to what I’d see back home at our ER. There was a bronchiolitis that I wound up admitting for further treatment. Some viral URIs, Constipation, Hand, Foot and Mouth disease as well as an AGE.

There was an infant with a new onset fever after several days of URI & diarrhea who looked great but the fevers were high! I was concerned for UTI (especially with the large water stools she was having and I witnessed) but we didn’t have the bags available to get a urine specimen and there were no catheters. I had to make a decision on whether to treat empirically or manage conservatively. That was a tough one.

I had another young lady presented with severe left sided abdominal pain with difficulty ambulating. She was diffusely tender on exam but her pain localized to the left. Urine pregnancy was negative. Urine dipstick was WNL (no blood). No flank pain and denied constipation. She had me very concerned for a surgical emergency and I was unable to obtain ultrasound for diagnosis. After a bit of discussion we got a flat and upright abdominal X ray which showed a large stool burden and after a glycerin suppository she felt much better. She even ran up to hug me and said thank you before she left. It was a reminder that I am helping in some ways (even if I’m not as efficient in the setting I was in.)

Overall, I had a wonderful but busy day! Coupled with the long drive home, I didn’t have the energy to write this post that day, but I’m excited to explore the other two clinical sites!

~ Iréal
4 Comments
  • Dr. Ireal: It will be interesting to know…. what was your final decision?, re: ” infant with high fevers after several days of URI and diarrhea”

    Iyer

    • It was a difficult decision to make and may have been different if I could reliably know that the patient would return to the clinic and we’d have the ability to take a sample at that time.

      Considering her symptoms had been ongoing for a week with no resolution and she’d started with new high grade fevers made me concerned for a bacterial super infection. On exam her lungs and TMs were clear with no signs of infection, and she had a VERY large loose/watery stool while in the office so UTI was very high on the differential. I ended up empirically treating though I’m sure my decision would have been different had I been comfortable knowing she’d be able to return if her symptoms persisted.

      How would you have handled that if you were in my situation?

  • Diane Pollard |

    Thank you so much for your support and love of the children! We are thrilled to have you join the family of Issa Trust Foundation.

    Diane Pollard, President & CEO

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