PROVIDENCE - Two pediatric residents spelled out the mystery of the day in medical shorthand, writing on the chalkboard of the nursing arts auditorium in the basement of Rhode Island Hospital.
Concentrating on four case studies, they borrowed elements of a format used in weekly continuing education discussions for physicians.
But they tailored their presentation to eighth graders from the Roger Williams Middle School, 14 members of the Young Doctors' Club who board a yellow bus twice a month after school for a short ride to the hospital.
Senior resident Dr. Loida E. Bonney challenged them to solve the mystery.
"Which one of these patients is the sickest?" she asked.
The answer was hidden in plain sight, among the vital signs -- temperature, heart rate, blood pressure, respiration, and the percent of oxygen saturation in the blood.
"Doctors have a lot to write, so they use symbols," Bonney had explained.
Bonney and her partner, Dr. Tracie Wolbrink, guided the students through the numbers for each of four young patients identified by age and gender.
And the teenagers warmed to the task.
Did the 16-year-old boy with a temperature of 98.9 degrees have a fever?
"No," called out one student.
Bonney reminded them that there is a range of normal temperature, from 97 degrees to "100.3-ish."
The next patient, a 12-year-old boy with a temperature of 102.5 degrees, clearly had a fever.
And Jahelia Olivero spotted the fact that his blood was not getting enough oxygen -- 89 percent saturation instead of the normal 100 percent.
Moreover, the boy's blood pressure was low, and his heart and respiration were too fast, the students quickly figured out, with a little guidance from Bonney and Wolbrink.
The residents mined the vital statistics of the 12-year-old boy for a quick review of the basics on body temperature, heart rate, blood pressure, respiration, and oxygen saturation, along with examples of the dynamic relationship among them.
"Why is the respiratory rate fast?" asked Bonney.
"Because the patient is not getting enough air," one student replied.
A lack of air also makes the heart beat faster, Bonney pointed out.
So does low blood pressure, Wolbrink added, with the heart working harder to pump blood to oxygen-hungry cells.
Now the group moved on to a diagnosis.
Bonney and Wolbrink told the students the boy had come to the emergency room with his mother. They passed out sheets that might have been written up by the emergency room physician who interviewed mother and son.
The boy had been coughing hard for two days. Besides a fever, he was congested, breathing hard, and listless.
The discussion meandered to the causes of these symptoms until the residents steered the conversation to some additional diagnostic tools -- blood tests and chest X-rays.
Islindy Merius suggested that a high white blood count -- detectable in a blood test -- would indicate an infection, because white cells fight germs.
The entire group proved very talented at reading the X-rays, purportedly of the 12-year-old boy. A front view and a side view of the lungs were clipped to a light box.
The students had no trouble spotting the pneumonia in the boy's lungs -- hazy to solid white patches in place of the dark spaces between the ribs.
"You should all be radiologists," Bonney said.
Not all of the students in the Young Doctors' Club are set on becoming physicians -- at least not yet.
Islindy says she loves the club. "It's a prep course. I want to be an ob-gyn" -- an obstetrician and gynecologist, she said.
Ramon Rodriguez wants to be a psychologist, but joined the club to broaden his experiences.
The Young Doctors' Club is tempting him in other directions, he said, but he needs to see more before he changes his mind.
Jahelia Olivero said the things she learns in the Young Doctors' Club are "very helpful."
For example, everyone should know about vital signs, in case of emergency, said Jahelia, who is thinking about a career in medicine or other fields.
She volunteers as a recovery room aide for patients undergoing relatively minor surgery who are well enough to go home a few hours after they come out of the operating room.
Jahelia says she brings patients a little food and sometimes wheels them to the door, where they get into waiting cars.
The club adviser, life sciences teacher Renee Gasparri, said she helped arrange for the volunteer post for Jahelia.
Gasparri, who is nearing her 50th birthday, says she remembers what it was like to grow up poor in Providence.
Serving as the club adviser and helping her students gives her the "satisfaction" of "giving back," Gasparri said.
"Possibly touching the lives of kids gives me happiness and peace inside; a sense of purpose and drive," she said. "I wouldn't be anywhere else."
As a young black woman wearing a doctor's white coat, the letters MD after her name, Bonney, in particular, serves as a role model for the students.
In fact, she says, she was much like them when she was growing up in Brooklyn.
She certainly wasn't thinking about medicine in the eighth grade, Bonney said, but she had mentors preparing her to apply to a competitive college.
She went to Johns Hopkins University for her undergraduate work and back home to Brooklyn for medical school at the State University of New York-Downstate.
A program like the Young Doctors' Club is very important for urban schoolchildren in "igniting that spark and letting them know they can aspire to the things they don't see every day," she said.
In fact, she said, the Young Doctors' Club "is creating another norm for them," she said.
The club meets weekly, alternating visits to the hospital with sessions at school.
Students recently added monthly trips to the nearby Health, Science and Technology Academy for meetings with high school students in a similar club, according to John Morgan, the hospital's liaison with the Young Doctors' Club.
Working with the healthy adolescents in the club is part of the training for residents such as Bonney, Wolbrink and others who are in a program that combines internal medicine and pediatrics.
Dr. Dominick Tammaro, co-director of the combined training program , said it turns out "very versatile docs who are equipped to care for newborns right up through the elderly."
As a program geared to placing physicians in primary care positions in underserved areas, Tammaro said, it has been able to support the Young Doctors' Club with a grant from the federal Department of Health and Human Services intended to help encourage adolescents to pursue careers in health-related fields, Tammaro said.
The residents rotate in preparing presentations, which sometimes involve professionals in other fields, Tammaro said.
Earlier in the school year, when the Young Doctors were learning about blood, "we took a blood sample from their teacher, which they thought was way cool," Tammaro said.
While the laboratory technician stained a blood sample, the students asked her all kinds of questions about her background, her training, and her job experience, Tammaro recalled.
The Young Doctors' Club aims to capture students' interest when they still have a chance to take the courses they need for a pre-med program in college, said John Morgan, human resources community liaison specialist for Lifespan, the hospital's parent organization.
And Morgan said Lifespan officials will go in the spring to Roger Williams Middle School as part of the Rhode Island Scholars program to urge all eighth graders and their parents to insist on rigorous academic courses for ninth grade and beyond.
"These upstream interventions are so important," Morgan said.
In his work, he said, he has encountered too many high school seniors who say they want to be doctors but haven't taken the prerequisites.
"It is tragic," he said. Morgan said these students often end up doing remedial work at the Community College of Rhode Island.
"These are our future human resources, especially if we're serious about trying to attract a diverse workforce," Morgan said.
He said the hospital would like to make enough connections in the community to "grow our own workforce," but that goal is "easier said than done."
Gasparri, the club adviser, says that there aren't enough opportunities like the Young Doctors' Club to go around at Roger Williams.
There was so much demand for the club this year -- its fourth -- that membership had to be limited to eighth graders, she said.
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