Just 17

One thing I don't miss at all about adult medicine is having patients several times larger than myself. I had a run of teenagers in clinic today, from the largest 12 year-old I've ever seen (over 6 foot and weighing 85 kilos) , to an autistic 18 year old whose mom has to shave his unruly facial hair.

12 year old boy, learning disability, seizure disorder, behavioural problems. Mom worried about sexualised behaviour ever since started sex education at school. Good school reports but mom struggling to cope with behaviour at home. Mom unwilling to be referred to our pschologists as boy managed to fall out with one over "talking about poo" a few years ago when he was referred for problems with soiling. EEG - no seizure activity but suggests epileptic tendency. Plan: refer to clincial psychology at Big Famous Hospital; start carbamazepine.

16 year old girl, accopanied by mother. headaches since age 6 years; pineal cyst on CT at age 7; thought to be benign. Headaches increasing in severity and occasionally waking her at night. 2 year history of sudden "blackouts" always associated with yawning and stretching. Family history of migraine. Meds: propranolol as migraine prophylaxis - but patient had stopped these herself 6 months ago. Impression: likely carotid body hypersensitivity syndrome; plan: ECG, refer to cardiology. also MRI brain. Adult or paediatric cardiology?


18 year old boy, high functioning autism. Mother opens the consultation by whipping out Certificate of Achievement from vocational taster course and beaming proudly at me. I try to look suitably impressed as she relates that he can walk to the DLR station and get to college all by himself. (but still needs help shaving and supervision bathing). He looks about 20, with marked 6 oclock shadow and scraggly moustache despite it being 3 oclock in the afternoon. Is on fluoxetine for anxiety; mom feels this helps. I wonder if it is appropriate to refer him on to the adult clinic?

And others. When do you refer to adult clinic? I guess the patient attending clinic on their own is always a good sign. It's the age old question. When is one truly grown up? And what matters more, mental or chronological age? Part of the reason teenagers unsettle me is I guess deep down I do feel as if I am still living in much-extended adolescence myself. Each birthday I think, maybe I will feel finally grown up when I....
live independently? - nah, been doing that 10 years now
graduate? - that was a while ago now, but that didn't do it
start work? - that didn't do it either
watch someone die and then have to speak to their relatives? - nope
make a 'good save' that keeps someone alive? - nope, not that either
get married?
have my own children?
become a consultant?
buy a house?
who knows. maybe the moment you stop growing up is the beginning of the end.