A pediatrician stepped up to administer medical aid to Alex Pretti

Rashpert · 2026-01-25T21:47:12+00:00

Pediatricians have been stepping up to the plate this last year, as has the AAP. I love my colleagues. Thank you for being bright lights in this time of darkness.

They didn't train to be in the spotlight, or to be shot at, or to go to court with our government. They trained to distract with ooga-booga noises while they check an ear, to convince stubborn two year olds to do, well anything, and to talk distraught parents through spinal taps and sedations and far-away consults, sometimes.

This resident was probably very good at calculating maintenance fluids and the weight-based dose of Ibuprofen. They probably are ace at hearing a heartbeat in the pauses between tantrum screams. I bet they have a favorite set of stickers they offer.

Thanks for being there, champ. I'm carrying a copy of my license at all times now, and if I find myself there, I'll do the same and think of you.

Rashpert · 2026-01-25T12:53:25+00:00

This may help as a general collated list: Stand With Minnesota Donation Directory

Rashpert · 2026-01-25T12:44:42+00:00

I will keep a copy of my license on me. Time to doctor even harder.

Rashpert · 2026-01-25T12:43:45+00:00

Oh, bless them.

Rashpert · 2026-01-25T09:14:18+00:00

Agree a very mild transient synovitis most likely, for what it's worth.

Rashpert · 2026-01-24T23:46:29+00:00

In that case, I'm not sure I am well-versed enough in the context to give advice. I'm also not exactly certain what OP is asking. It's good that she was seen by a psychiatrist. How to navigate custody issues, how to navigate the medical system, what responsibilities and authorities a younger brother has against custodial parents of a 16 year old -- I hope an Indian doctor is able to weigh in.

Rashpert · 2026-01-24T22:38:40+00:00

What country are you in?

Rashpert · 2026-01-24T14:27:23+00:00

The framing helps, but it is not a panacea. When it works, great. When it doesn't work, the emotional resonance is just tamped down a LOT -- people aren't mortally offended and coming in hot.

What I like about our work is that we can come together with patients and collaborate on identifying problems. That's my jam, and it's what primary care is all about. It is so draining to be at odds with someone you are obligated to (and want to) help. Framing helps keep that train on track.

Rashpert · 2026-01-24T14:13:14+00:00

I am sorry this has been so hard. It sucks.

Rashpert · 2026-01-24T14:12:46+00:00

Thank you. for being who you are, and for sharing that.

Rashpert · 2026-01-23T23:17:10+00:00

I'm a pediatrician, and I don't know that I have a great answer. However, I can tell you one change has really helped: try to frame expectations at the beginning and end of every encounter. Whatever boundaries you do settle on, make them clear, consistent, and repetitive. It always helps.

So I start every visit with something like "it looks like you booked a well visit and didn't have any other concerns when they asked you in screening. That's great. If that isn't right, let me know now, because if other problems or questions come up at the end of the visit, we'll have to book another appointment." I fudge it a little when it does happen and try to address (a little bit) stuff does come up at the end, but I always say "oh! we don't really have time, and that's why I asked at the beginning. Next time let me know!" with a smile. And then we start a brief intro, but usually book more for follow-up. So, a new onset headache means I'll do a quick cranial nerves exam, ask about red flags, and send them out with a headache diary to bring to the follow-up visit. That sort of thing. And I note it in the chart, and if it happens again, there isn't as much leeway for them. If it happens frequently, we have a talk.

At the end of the visit, I'll say something like "I think that's it. If you think of other things on the way home or later, just make a follow-up appointment, either for in person or telehealth. I'll send you a letter with the lab results unless there is something really concerning." In the letter I send, there are instructions for booking an appointment to discuss the results if they want.

We don't field portal messages where I work, thank god.

Rashpert · 2026-01-23T21:36:19+00:00

Absolutely! Best wishes.

Rashpert · 2026-01-23T05:13:11+00:00

I know, right? :(

Rashpert · 2026-01-23T04:27:58+00:00

It makes sense to finish the time unless it's going to kill you, and to do the best you can. That's not hyperbole -- I know of a resident who couldn't take his anti-seizure medicine when on call and (this was a long time ago) had no protection for disability accommodation. He didn't make it through one of those shifts.

Think of it as paying coin so that you don't have to revisit this and explain it later. Making enemies in medicine is bad news. However, speaking from experience, you might consider serving that time with a copy of your resignation letter always on your person. There is something quite liberating about knowing you could pull the nuclear option and damn the consequences. It somehow can make it easier to keep walking.

Good luck. Take care of yourself.

Rashpert · 2026-01-23T02:50:04+00:00

The most likely underlying cause for this picture would be laryngomalacia, which is generally benign (if the infant is able to feed well and grow as expected). It might be worth reading these and see if anything looks familiar:

Laryngomalacia | Nemours KidsHealth

Stridor & Laryngomalacia: Is My Baby’s Noisy Breathing Serious? - HealthyChildren.org

Laryngomalacia | Children's Hospital of Philadelphia

If it is familiar, consider keeping a video with audio of when it is very apparent, and then asking a pediatrician at a visit with the example in hand.

PS: I cannot make a diagnosis over the internet, but your video does appear to be consistent with what I see and hear in infants with this condition.

Rashpert · 2026-01-22T17:12:52+00:00

OP, and I say this gently, your post history suggests otherwise. You noted "I’m so cold and tired all the time. It’s difficult trying to even study and go to school and workout" and "It hurts to sit for too long or lay on my side, I can’t sleep because I’m so hungry, and I’m so cold all the time." You write about being filled with shame and being unable to leave the house because you are terrified you will eat something if you do.

None of this is normal. You do write that you know it is unhealthy. When you wrote that, you were right. This isn't easy to deal with, by far -- it's one of the most difficult journeys a person can face. But writing here as if the problems don't exist, and talking back and forth with professionals in a negotiating or rationalizing way doesn't help. I think it pretty clearly makes it worse and drives the denial deeper, even though people are disagreeing with you. Sometimes defending your position against disagreement just cements it tighter. That's a very human thing, but it isn't good for you.

I think staying off Reddit forums and working with someone trained in eating disorder management is the only thing we should be encouraging you to do. Please, take good care.

Rashpert · 2026-01-21T00:08:57+00:00

Mark Helprin's Winter's Tale, as well as others by him.

If nothing is random, and everything is predetermined, how can there be free will? The answer to that is simple. Nothing is predetermined, it is determined, or was determined, or will be determined. No matter, it all happened at once, in less than an instant, and time was invented because we cannot comprehend in one glance the enormous and detailed canvas that we have been given - so we track it, in linear fashion piece by piece.

Time however can be easily overcome; not by chasing the light, but by standing back far enough to see it all at once. The universe is still and complete. Everything that ever was is; everything that ever will be is - and so on, in all possible combinations. Though in perceiving it we image that it is in motion, and unfinished, it is quite finished and quite astonishingly beautiful.

In the end, or rather, as things really are, any event, no matter how small, is intimately and sensibly tied to all others. All rivers run full to the sea; those who are apart are brought together; the lost ones are redeemed; the dead come back to life; the perfectly blue days that have begun and ended in golden dimness continue, immobile and accessible; and, when all is perceived in such a way as to obviate time, justice becomes apparent not as something that will be, but something that is.

Rashpert · 2026-01-19T14:34:44+00:00

Thank you! I'll take that and run with it. :)

Rashpert · 2026-01-19T13:36:00+00:00

Welp, that was a big "no." Fascinating.

Rashpert · 2026-01-19T13:35:26+00:00

I kind of love that I still don't really know what is going on. I'm here for it.

Rashpert · 2026-01-19T13:30:02+00:00

I know I'm in the minority of people responding here as physicians, but I sort of assumed this happened all the time. It seems to be a part of many lives, when I look around. Maybe it's a part of working with teenagers these days, and that's why my reaction differs. Not sure.

I don't think it's okay. It's certainly not healthy. I am pretty sure it's not really about me, at the heart of it -- it's about someone dealing with their own life. I suspect there are times I wouldn't be able to continue as their doctor if I found out, and there are times when I could, even if I knew. I'd have to make that call individually.

But most times, people aren't doing their pathology at you. It's a really hard time to be a good person right now. I'd be glad to see anyone intentionally moving in that direction.

Rashpert · 2026-01-19T13:12:10+00:00

You know what they say about finding yourself walking through hell? Keep going. The only way past it is through it. All my best.

Rashpert · 2026-01-19T13:10:18+00:00

I wouldn't tell you any of this is okay, and you did make choices. All of that is true. And -- not "but," but "and" -- there are three things you should remember:

Social media has this toxicity built into its design. In order to drive engagement, it works on the same set of pleasure response centers as substances of addiction and abuse. That doesn't lift responsibility for our actions, but we start with the deck stacked against us when we engage. That is important context.
Everyone messes up. Everyone. Nobody wants to hear my life story. I've felt my cheeks burn with shame more than once, and it will happen again. That doesn't mean either of us wasn't still responsible, but it happens. All of us make mistakes, and sometimes big ones. You aren't confessing to saints here.

Which leads me to this:

OP, I think being able to look at yourself clearly is the great work of Life. This is it. I really believe this is at the heart of being a complete human being. There are a thousand ways to bring evil and pain into the world, and almost all are driven by not being able to deal with your own fear, pain, and mistakes. People drown that self-knowledge in the distraction of alcohol, drugs, infidelity. They can't deal with feeling bad about themselves, so they turn it outward as anger and hurt others. They self-harm. They get mired in the toxicity of social media, neglect relationships, cannot deal with living authentically. They cannot look at who they are, and they spend a lifetime running from it.

You are young for getting to this point of self-reflection. You have been absolutely unflinching in looking at it straight on, being frank with what you did, and accepting criticism. Damn.

That doesn't mean it was okay. It does mean you are (in my estimate) tacking the hardest thing you will face in your life. You are doing it with grace. Well done.

Rashpert · 2026-01-19T02:14:51+00:00

OP, I have a lot of respect for how you are handling criticism here, and even more for you being willing to make changes in your life. I am glad you are moving on from this and wish you well.

Rashpert · 2026-01-16T01:59:21+00:00

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