Bright yellow baby

I spotted him from the waiting room, a happy, chubby thing the colour of Bart Simpson. Perhaps I should have noticed then that the whites of his eyes were quite clear. He had attended the ambulatory care unit the week before with a 'viral rash'. On examination, it looked more like really bad eczema. He was otherwise very well, but his colour concerned me. I decided to take some blood to measure his bilirubin level. Just then, one of the staff grades walked by. She's really experienced and was a GP before training in Paediatrics. She took one glance at the baby and exclaimed, "Hypercarotenaemia! I'd put my money on that. Bet you his mother feeds him lots of mashed carrot and sweet potato and organic baby food jars." His bilirubin came back at 6. I swallowed my pride and took my medical students to see him. Sure enough, he was halfway through a sweet potato-based organic baby food jar. My excuse is that I've only ever worked in paediatrics in East London before this job, where you wouldn't see the orangey yellow as they're all Bengali. And they probably don't get organic baby food.

Several hours (and countless wheezy/feverish/vomit-y patients later) , my bleep went off, and it was an ambulance crew with a 6 year old boy in SVT (supraventicular tachycardia). His mother had tried vagal manoeuvres at home, without success. An ECG confirmed the diagnosis, recording a heart rate of 190 per minute. We had the adenosine ready, and I chatted with the boy to distract him while the A&E doctor put an IV line in. "So you're off school for half term then?" I said. He nodded and tried to smile. "What have you been up to today?" "My cousins came and we played on the trampoline (gasp), and then we had tea (gasp) and then we were watching telly (big gasp) and then I had my heart attack," he said, as if it were quite an ordinary thing. Everyone round the bed smiled for about a second and then realised it wasn't funny, he was probably having severe chest pain and feeling very short of breath. Just then, the cannula went in. "OW!" he screamed. The local anaesthetic cream hadn't had time to work. He went all sweaty and pale, and then his heart rate flipped back into a normal rate and rhythm. So we didn't need the adenosine after all. Having a cannula inserted had literally cured him. The funny thing was, the A&E doctor had wanted to put in a yellow (i.e. smallest available) cannula but I argued for a blue (a size up) and won, as adenosine is meant to be given as a fast bolus (i.e. as quickly as possible). Perhaps a yellow wouldn't have been painful enough?