I have been marinating on my Pediatric experience (known as Peds in med-speak). Since we’re not left with much time for personal reflection in this ridiculously accelerated program, I haven’t really known what to write about it…a longer marination than is normally necessary for a spring chicken.
I guess the geriatric population was easier for me. It’s not always easy to see someone grow older, weaker and sicker, but I find it much more “right” and natural than seeing a kid in pain. Hopefully the elderly have lived long, fruitful and productive lives and feel full to bursting with rich experiences. While I know this is not always the case (and I know this is going to sound a bit uncouth/crude) at least they had their chance, right? What chance does a 5-year-old with leukemia get to truly live, run and play? What about the 14-year old boy knows more about his brain tumor and T cell count than about the English, Math, or Social Studies that his peers are studying in high school – which he hasn’t even been able to attend even once due to his illness. How can I even begin to relate or fathom the unfairness? I can’t yet, and I know I can’t. They tell us that we have to empathize yet at the same time somehow manage to avoid sympathy, but let me tell you, that is a mighty hard thing to do when a scrawny, bald chipmunk-cheeked teen boy with impossibly long eyelashes is trying to choke back tears while telling you how scared he is of his disease, but ironically even more scared to go back to high school where he will be “looked at funny” by his fellow classmates. How do I respond to that? Or when I watch him nervously vibrate his wasted leg while speaking with the attending doctors about his disease progression, and what exactly they mean by “plan B” if the chemo and doesn’t work this time, just like it didn’t last time, or how the surgery didn’t the time before that. Instead of protecting him, which I can’t do, I do the only thing I can do which is treat him like a normal boy, and work on a puzzle with him, hoping that for a single second maybe he will forget where he is and what he is dealing with.
Doing my rotation on a hematology oncology floor of a children’s hospital is difficult in many ways. Every morning I steel myself for the onslaught of emotions, and sometimes I do it too well, and then I just feel numb. But that isn’t right either and I obviously haven’t found the perfect balance. When I am numb, I am ineffective. Like when you have a numb cheek from Novocaine, you chew funny, you feel awkward, and something’s just not right. That’s how I feel on the Hem-Onc floor and I know it’s not quite right either even if I am not running out of every room sobbing which clearly would be even worse!
On Thursday, I had the amazing opportunity to do a day-long rotation in the Pediatric ER. Ironically enough, however, the first patient of the day was a teeny weeny 3-year-old with leukemia presenting with a fever and elevated heart rate. The poor little girl knew what was coming, she had been there enough times to know the torture that was about to ensue as we poked her with needles, drew labs from her central line, and hooked her up to an EKG. The entire time she whimpered and cried, but remained incredibly compliant. As her miniature chest heaved with sobs, she held up her shirt for us to access her Broviac with a bigger needle than has ever been stuck in me! When asked which finger she wanted her pulse oximeter monitor to be placed on (completely painless) she still cried but held up her trembling right index finger for us to wrap it on. The entire time, Mom was curled around her poor little baby, comforting and soothing and wiping her tears. Dad was standing by, murmuring soothing words to his little girl. The older brother was also there, sitting quietly in the corner, obviously accustomed to these events. My emotions totally got to me here, I hadn’t felt prepared to deal with a leukemia patient on my day in the ED. I swallowed the lump in my throat and blinked quickly a few times. But in a weird way, it felt right. I was seeing treatment from a different angle, and in this case it was reassuring. The nurses were incredible – even in an emergent setting, they were calm as can be. They reassured their patients with their demeanor and caring touch. They moved efficiently. In a matter of minutes, this little girl was assessed, and labs were sent off. We moved on to the next patient of the day…and then the next…I saw so many different things and I saw the beauty of how well triage, nurses, support staff and attendings can all work together to care for people in distress. It was amazing and I learned more in a day than I feel like I do in a month of didactics. I know both are necessary for my learning, but this was also food for my soul.