HCDM 55 | Pediatric Emergency Medicine

 

Seeing little children suffer from various medical emergencies can be a heart-wrenching experience, but you don’t have the luxury of time to wallow in pity if you’re the pediatric emergency medicine physician on duty. Nkeiruka Orajiaka grapples with this reality every day. Born and raised in Nigeria, Nkeiruka has always been passionate about medicine and she especially likes working with children – a quality that she believes to be essential for anyone who is seeking to start a career in her field. Learn more about what a day in the life of a pediatric emergency medicine physician looks like as Nkeiruka gives us a detailed description in this conversation with Dr. Richard Marn. Plus, learn about Nkeiruka’s loftier goals in global medicine and her newly found path to explore her other passions.

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A Day In The Life Of A Pediatrician, Emergency Medicine With Nkeiruka Orajiaka

Here’s an announcement before you get started on this episode. This episode is number 55. Can you believe it? This episode marks the one-year anniversary of when this show came out. It’s pretty awesome. I’m very proud of that. It wouldn’t have happened if I didn’t have a great set of guests. I’ve been very fortunate and lucky to have the guests on this show. They’ve been phenomenal. If you’ve read some of them, I think you would agree. They’ve not only provided deep perspective of their career, but also inspiration. Thank you, guests, for being a part of that. Also, I want to thank you as a reader. Thank you for reading these episodes. Thank you for providing feedback, perspective, advice and just being supportive. Our readership has slowly been growing and growing, and it means that we’ve been having an impact. I appreciate you guys for being supportive there.

Also, thank you for my team. They’ve been fantastic. They’ve been so supportive and awesome that some of us are actually going to take a little break. After episode 55, myself and my team members will be taking a break from running the show. It takes a lot of time and effort to put the show together. My blogpost creators, my editor, my social media manager, as well as the rest of the team that help support each of them, we’re all going to take a little break. During that time, we’re also going to be strategizing and figuring out how we can make this show even better than what it is, and have an even greater impact than what we’re doing right now. That’s the goal and that’s what we’re going to be doing.

The question now is when are we coming back? Most likely early July 2021. The best way that we’re going to be letting people know is through our email newsletter. If you’d like to get on that email, please share your email on the homepage of my website, HealthCareersWithDrMarn.com. I promise you, I don’t give it out. I don’t give any spam. It’s just to let you know when the next episode is coming or any other announcements. I keep your emails safe and sacred, and I don’t abuse it. That’s one way to do it, as well as checking out my social media. I may be making an announcement there as well when the next few episodes will be coming out. Don’t disappear. I want you to continue reading. I believe that we’re going to make this even better than what is now in its current state.

Thanks for joining me on another episode. I’m glad you’re here. We’re going to talk with someone who specializes in taking care of kids, but in an area where families are not always at their best selves. We’ll learn a little bit why that is in this episode. We’re going to talk with Dr. Nkeiruka Orajiaka. She is actually a pediatrician who specializes in ER or Emergency Medicine, otherwise known as a Pediatric ER doctor. We’ll learn how she came from Nigeria, where she actually grew up and trained initially, and then came to United States where she became a Pediatric Resident and Pediatrician. She now works for a major academic children’s hospital in the United States.

It’s a little bit of a success story, in my opinion. It’s very inspirational, some funny stories, and you get a real sense of what it’s like to be a Pediatric ER doctor, where you can really have some immediate impact on a lot of patients. If you like what you’re reading on this episode and other episodes, I encourage you to please give me a five-star rating if you think it deserves it on whatever podcast app that you’re using. That would help to bring awareness to this show to other people that may be looking for this resource. That would be very helpful. I appreciate your support for those who have done that. I encourage you to help me and support me in this little small endeavor. Without further ado, let’s jump into it.

Nkeiruka, can you tell us a quick bio about yourself?

I’m Nkeiruka Orajiaka. I’m originally Nigeria. I was born and raised in Nigeria. I studied in a medical school in Nigeria, then I moved to United States for my Master’s in Public Health at Columbia University, which is about a year and a half. I moved back again to Nigeria for a few years to work. Then I moved to the US where I did my residency at Harlem Hospital, which is an affiliation of Columbia University. I did that for three years, the Pediatric Residency Program. I am now an attending pediatrician who practices Emergency Medicine in Columbus, Ohio.

Thank you. As a Pediatrician specializing in ER Medicine, what do you do exactly on a daily basis to help people?

That’s always an interesting question when they ask me, “What is your day like in the ER?” Every day is different, which is why I like it. People call me for different things. You have different conversations. I typically work eight-hour shifts, and I do about 3 or 4 of them a week. It depends on the week. I’m seeing patients with different things, injuries, medical-related infectious disease illnesses. Sometimes, I assist in a code, admitting patients, procedures, blood work, sedations. That’s a whole lot of fun things in the ER, and then having conversations with families. There are interesting and not-so-interesting discussions in the ER.

To achieve your degree, what’s the usual steps to get there?

It depends on where you’re starting from. I did mine in Nigeria, so mine is a little bit different. Outside of the country, in Nigeria, you go from high school, which is what we call a step straight to medical school, which is 6, 7 or 8 years, depending on what the situation of the country is. Mine ended up being eight years. After that, you can go ahead and do your residency and the specialty you wanted, which is what I did in the US. My trajectory is completely different because I finished medical school, did a Master’s in Public Health, worked in public health for a while before I came back to residency. You’re looking at someone who wants to do the whole route. It’s high school or secondary school, medical school and residency.

What’s the best part of your career? What part do you really love?

First, I’m able to help and make a difference in kids because I love the kids population while taking care of them. Secondly, with the ER perspective, is the fact that I can do different things in one day. I can go into a critically ill child, doing something significant like saving them, and then go and have a conversation with the child, who’s completely fine but the parents are worried and they’re just happily in there in the whole room. I think it’s the variety of being able to see different things in a day. You’d be able to see different things from one to the other, and that makes it for me.

People are rarely their best selves when they come into the ER. You have to have a lot of empathy to give your patients the best care. Click To Tweet

What’s your least favorite part of your career?

Working in the ER, we’re the first point of call for different patients, and that can be really sad cases, from situations to an injured kid in a motor vehicle accident or sexually assaulted kids. You tend to see some things that haunt your memory, that you always remember the three-year-old who was involved in an accident and was naked, or maybe a really sad case who was sexually assaulted and wondering where they’re going to end up. Those are the memories that it’s something I have to do, but those are the ones that are at the back of my mind, that’s not my most favorite part of the job.

Those heart-wrenching situations, especially when it’s dealing with kids. I’d love to hear a story or an example where you’ve taken care of somebody that you think had an impact on these kids. Could you share 1 or 2 of those stories?

I will share one that I saw. I’ve been working now for a few years and I saw this kid involved in a motor vehicle accident and of course, I went. I can’t remember the specifics of what they came in with, but they ended up admitted for a couple of months and they were fine. They did okay luckily and went home. Then I ended up seeing them in the ED again for a completely different situation. I was surprised the mom remembered me. Another thing with kids, they’re very resilient, “I remember seeing you near death and you look so amazing now.” Those are the news and the stories you hear. I am happy that I’m making a difference. Those are one of the stories that melt my heart too.

Even in Emergency Medicine, you don’t really have that much continuity of care. Is that a true statement?

Yeah, you don’t. When I see this kind of continuity, I’m excited.

I know we’ve touched on it briefly, but what is your typical day like? Could you give them more details? What time do you usually show up? Who do you work with and when do you get off?

It depends on the shift I’m doing. We have 3 or 4 main shifts in the ER, which are eight hours. It could be 6:00. It could be 2:00. It could be overnight. We start from 10:00 or 11:00. If I’m working the 6:00 AM shift, I typically would have to wake up before 5:00 because I have kids too, so I want to make sure things are settled before I leave. I wake up before 5:00, get everything ready. I get there probably 5:55 or 5:50. We always have someone who went the night before, so you get sign-outs where they give you details if they have any patients who are not completed or things that are pending to be done with the patient.

I have worked closely with the residents and medical students. If I have a resident available, they tell me about a patient they’ve seen and we go over the patient, have some teaching moments, learning moments. Then I see the patient and we decide on a plan. Depending on the day, between 16 to 20 patients or more in my eight-hour period where you’re having decisions based on the plan, you’re talking to the families based on what you think should happen, listening to what their concerns are, reviewing the blood work, the X-rays and talking to consultants. In ER, we work closely with a lot of other departments. We’re talking to them about patients, coming up with decisions, and either discharging a patient versus admitting them for the care. This was up into eight hours and a half, then I sit up to another doctor who continues the care if there’s one available.

Do you get to choose the shifts that you work on or is that something like as a junior attending, are you getting the worst shifts necessarily? How does the decision on shift-work work? If someone’s reading this and they’re like, “I could be getting the midnight shift every day for the next five years.” Is that necessarily true? How does this all work out usually?

It depends on where you work. Luckily, where I work, we always have to submit preferences, like if you want to work more days versus nights, you get the opportunity to do that, but that does not mean you’re going to get all the nights. Let’s say for instance, if I want to work eight nights, there may be someone else that wants to work at night, so I may end up like 6 versus 7, but our preferences are to be reconsidered. At some point, I wanted to work more days, but now I’m working fewer shifts. I actually like the nights because with my family and kids, it was a little bit better for the situation. I have some nights and some days, but our preferences are considered before the schedule is made, so that’s good.

It sounds like because you have some flexibility in the type of times and days you’re working, that for certain people that could be a very nice work-life balance. You can change it as you need it, “I want to work nights for a while and then I want to work days.” There’s some flexibility. You can also pull back.

That’s one of the good things I like about working in the ER. It’s shift days. When you’re done, you’re done. You’re not going back or they’re not calling you to consult for one person or the other, unless maybe you want to talk about a patient. Once you’re done with the ER, you’re done. You can have random days off between Monday and Wednesday, which some people might be at work, but then again on the flip side, you may have to work weekends and nights. I like the balance of being able to hang out with my kids on random Mondays and Wednesdays and all that fun stuff.

What are some misconceptions people have about your career?

People are focused on the amount of money you make. Some people will tell you, “You’re already a doctor, you’re working and making a lot of money,” which is good. We make good, but then I’m not sure they forget the work behind it. We do work hard a lot. When I was in residency or doing the early years of my career, there were some hours and weeks that I missed like my kid’s fourth, some different things. There are a lot of things you give up. People forget that. You’re paying back one way. Another thing is I feel like some people don’t remember we have feelings or emotions. They tell me, “You don’t understand, you don’t have kids.” I’m like, “No, that’s not how it is.” The fact that I have a blank face does not mean I don’t feel what you’re feeling. Sometimes, we have to hold ourselves together to be able to provide the best care for you. Those are the things that families may or may not understand. Sometimes I figure it’s just in the moment that their child is safe and they want to maybe bring their frustrations or something, so I don’t take it personally. That’s one of the things I tell that families forget that we’re human too. Those are some of the things that come up with them.

HCDM 55 | Pediatric Emergency Medicine

Pediatric Emergency Medicine: The fact that your doctor puts on a blank face does not mean they don’t feel what you feel. Sometimes they have to hold themselves together to be able to provide the best care for you.

 

I think it’s interesting to highlight. Correct me if I’m wrong, but because you’re in pediatrics, you’re always dealing with families, versus if you were in an adult ER, that’s not necessarily true.

When it comes to pediatrics, I always tell people you are dealing with two different patients. You deal with the patient themselves and the parents too. It makes it both interesting and difficult at the same time.

Changing gears a little bit. What do you think is the future outlook of this profession as a Pediatric ER?

Actually, Pediatric emergency is one of the newest specialties in pediatrics. In the past, people will go through the working pediatric emergency medicine without being pediatrics emergency medicine training. It’s a different fellowship. You could do another three years of fellowship to be able to be a pediatric emergency medicine trained specialist. When I talked about working in an Emergency Room, there are two different types of specialties. You can have pediatricians who have done three years of residency working at a section of Emergency Medicine, which is what I am.

Some of us do it as a step to see what the environment is before you do another three years of fellowship to work in pediatric emergency medicine. For you to be a pediatric emergency medicine specialist, you have to do 6 years, 2 years of residency and 3 years of fellowship. The fellowship is actually new. It’s something that’s still going. There’s a whole lot more people going into it. It’s getting more competitive in the past couple of years. I don’t think it’s going anywhere for now. I feel like you may classify more on different specialties under it, but in terms of growth, it’s one of the growing specialties. It’s getting very competitive to get into that.

Would you recommend someone who’s interested in this to do those extra three years, or at least plan to do those extra 2 or 3 years of fellowship?

Yes, and the reason is medicine is changing. For you to remain competitive, you have to catch up. As a pediatrician, I like working in the ER, but at some point over the next couple of years, I’m not sure if being a pediatrician alone is enough for you to work in ER, if that’s what you’re interested in. Some people don’t like to work in there. I’m a very fast-paced person, so I don’t like to work in a clinic. In the next ten years, I feel that only people who have pediatric emergency medicine fellowship training will be able to work in ER. I recommend those extra 2 or 3 years.

Are you thinking maybe for your future, you might do a fellowship?

I am planning on doing a fellowship. When we get to my trajectory, maybe we’ll talk about why I didn’t do it.

What is your trajectory? What are you thinking about doing yourself?

I am very interested in global health. I’m interested in doing my fellowship because at some point, I want to not just practicing in the US, but I want to be able to provide expertise outside of the country like in Africa. That’s something I’m willing to do at some point.

I remember we talked about that when we first met. You talked about wanting to be a doctor, not just stay at one institution for the rest of your life and work, but you want to take your skills eventually and help people across the world in many different countries, not just 1 or 2.

Yeah, definitely. That’s still the plan.

What type of students do you think would best flourish in this particular career?

When it comes to pediatrics as a whole, definitely someone that has a passion for kids, someone who has empathy. Empathy comes with medicine because there’s a whole lot of things. Patients don’t know how to talk to you and there’s no empathy. That’s one of the things. It requires a lot of patience because when it comes to pediatrics, you may walk into a room and have a child crying, and you have no idea what’s going on. It takes patience for you to have conversations to be able to figure out what’s going on. When it comes to our patients, it also comes with dealing with families because you have to know how to have conversations with families.

Having conversations with people who are not in the same career as you are makes you a better-rounded person. Click To Tweet

Bringing the ER aspect now, this is where nobody wants to be in the ER. People that go to their primary care doctors get dressed up, they get ready. They know they have an appointment and they go in. People who come to the ER probably ended up at one because the child jumped off a monkey bar, broke something or maybe two, they got sick in the middle of the night and now parents have no sleep. ER visits are never planned. You have to have the patience to want to know this parent may be frustrated because they’re waking up in the middle of the night to come back. You have to have some diplomatic, empathetic discussions with them to be able to give them the care, but also be able to reassure them. It’s a lot to be waking up in the middle of the night and get ready to go to work the next day after being in an ER for long hours waiting.

People are not at their best selves when they come to the ER.

I would not be if I’m the one too. You have to be able to understand those when you want to work in an ER.

I want to talk a little bit about you. You grew up in Nigeria. Were you thinking about being a doctor early on in your life, or were there other careers you’re thinking about pursuing?

I really wanted to be a doctor early on. I had no other major careers in my mind, maybe dancing at some point but nothing major. It’s a long story but my brother had an injury when he was 9 and I was 8. I was doing some wrap around and I just tied it around. The injury ended up going with him with my parents to the hospital. I was watching the doctor and I was mesmerized by it. I just want to do medicine. That was it. That’s how I ended up continuing the same path. In medical school, I was like, “Why am I here? Why do I have to do another study?” I always go through moments like, “I think I’m done with this,” because you have to study, you missed many activities with friends. I’ve always liked medicine from that point on.

Even when you were growing up, did you think about any other things to pursue as a career, or were you really set on medicine for a long time?

I liked the idea of music and dance, but it’s not something that I ever explored. I come from a typical Nigerian African home, which if you’re not a doctor, a lawyer or something, you don’t have a lot of options open to you. It’s not something I ever explored. It’s not something they tell you to do an elective, “Do this and see if you like it.” I liked medicine and I also liked dance, but I never really explored that option or say, “Maybe that could be a career, that might be something I may be interested in,” because I didn’t see it as something to do back then.

Is there anything you would change or do differently? If you had to start your career over again, would you do anything differently?

I think what I would do differently will be to see how to get exposed to other things. As much as I love medicine, I feel like it gives you a narrow-minded view of things. It’s only when like you’ve passed, you finished your career, you’re now working and you’re like, “What else can I do outside medicine?” Which I know now from a few people and thanks to social media, there are many things you can do outside of medicine. As a medical student or someone in high school, I think there should be opportunities for you to explore other things outside of your career. People can have passions. They can explore and handle it the same time they’re doing whatever career they want. It makes you more rounded to an extent. It makes you have a more rounded conversation with people that are not in the same career as you are.

In the short couple of years, I’m like, “The other things you can do, the other interactions you can have.” It doesn’t have to be only the people in medicine. I think that’s one thing I would want to learn or do differently. I do a lot of writing now, but that’s something I never really explored when I was younger. I felt like if I started writing when I was younger, it would have been a completely different thing now. Over the years, I’ve written a few articles and stuff. It’s not something I’ve learned earlier. It’s exploring other things.

That’s okay. You’re a late bloomer in that area.

I know. I’m just saying for other people that it’s something to think about.

I understand you enjoy blogging and writing, and you’re actually active on social media. Where can people find and learn more about you and what you’re doing?

I have a blog and my website is DrNkeiru.com. On Instagram, I’m also @Dr_NOrajiaka. Those are the two places I’m very active.

What are you doing on your website? What are you blogging about usually?

HCDM 55 | Pediatric Emergency Medicine

Pediatric Emergency Medicine: Someone who has a passion for kids, empathy, and a lot of patience is a perfect candidate for a career in pediatric emergency.

 

It’s different things. Because we never really have enough time to go through with families, what’s happening, with questions they have, I use that as teaching moments. I also use some stories about ER experiences and patients, and I also use those as teaching moments. On one aspect of it being a mom, I have like a motherhood section where I use stories of my own experiences being a mom, things I do. On one aspect of it too, I’m also an international medical graduate, which I know a lot of people want to know how I got to my path. Why did I do this versus that? How did I get to be an international medical graduate? It’s a mix of motherhood, medicine and migration stories.

Thank you so much for joining me on this episode. I really appreciate it.

Thanks for having me. This has been fun.

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About Dr. Nkeiruka Orajiaka

HCDM 55 | Pediatric Emergency MedicineI was born and raised in Nigeria and also completed my medical school in Nigeria. I fell in love with New York City when i moved to the US for a few years to obtain a Masters in Public Health from Columbia University New York.

Even though I moved back to Nigeria, it was only for a short while, ultimately returning back to New York City for my Pediatrics Residency at the Columbia University Medical Center affiliation at Harlem Hospital.

I am an American board-certified Pediatrician with love for Emergency Medicine. I am currently rocking the ER life in a pretty busy Children’s Emergency room. I am a mother of 2 tweens and a toddler. After living a few years in the city that never sleeps (aka New York City) and loving every bit of it, we now live the ‘suburbian’ life in Columbus Ohio, and still trying to figure it out.

I have a passion for children’s health and education and a strong believer that health education is the basis for maintaining healthy living.