5-12-2014
I had barely gotten out of the room when I started choking up. Took a detour to the bathroom to compose myself before heading back to the resident room for sign out. I knew rotating through pediatric hematology and oncology would be tough. I tried to mentally prepare myself for it. I think it hit me all the harder cause of it.
I've been at this nearly a year now, and have seem some pretty awful things. One patient I'd been helping care for for three weeks had quickly become my favorite. He and his family were always a welcome and enjoyable stop during pre-rounds or afternoons. His room always had new photos of grandkids, family, or OSU football. He'd made some improvements, but was not making much overall progress. All he wanted was to be home for Thanksgiving with his grandchildren, and have a home cooked meal. A week before, I headed out for the night. I'll see you in the morning, I told him. I came back twelve hours later to an empty, freshly cleaned room, complete with a 'Welcome to The James Cancer Hospital' pamphlet.
Or the time on L&D night call, after having successfully and without complications having back to back vaginal twin deliveries, the team had just sat down to have celebratory Tim Horton's. Right then, the senior got a STAT call to the L&D OR. A patient who 4 hours earlier was happy and laughing with her family with reassuring fetal signs had been rolled back for an emergent C-section. Less than five minutes from the initial incision, the baby was out, handed off to the neonatal team. They immediately started neonatal resuscitation. I held a retractor and tried to ignore the chest compression counts and calls of 'do we have a pulse? No.' In front of my eyes, the mother was having uterine hemorrhage and a flurry of activity was going on to tamponade the bleeding and sew her back together following the traumatic C-section. A midst all this, my gaze drifted to the head of the operating table. His hair was covered with a poorly fitted surgical cap, and his nose and mouth by a surgical mask. All I could see were his eyes. Through them I saw more than I can describe. Loss, powerlessness, paralysis, fear, terror, and more. I'll never forget that sight, that feeling. He wanted to protect his wife and child, but here he was, not only unable to do anything for either, but unable to even understand the chaos that was going on. All he could do was hold her hand. He and mom signed out AMA the next day to go to Children's to spend what time was left with the baby.
Today wasn't the sudden shock of things going wrong. For this toddler, things have been going wrong for a while. She has been in and out of the PICU, having a cardiac arrest with neurologic sequelae, infections and more, on top of a likely terminal cancer. Her prognosis is poor. Her mother understands this. She sees it 24 hours a day, every day. She sees the slow but steady addition of tubes, lines, and other devices. She see the daily blood draws and medication injections. I won't try to make assumptions about her feelings or guess at where on the Kubler-Ross model of grief she is. To do so would trivialize what she is going through.
But I did get a glimpse. A peek at what may keep her going, keep her strong in the face of such sadness and tragedy. As I headed out of her daughter's room, she looked at me, and with a slight smile told me, 'I hope the rest of your patients are doing all right today.'
A mother, who's child is so ill, on the day after Mother's Day, who has so many things on her mind, made a point to ask about the other children. I was absolutely floored. I still am.
Maybe I'm reading into it too much. Maybe she was just being polite. But, this event has so far reminded me of two lessons. First, the strength and resilience of mothers. She is going through the worst scenario that can happen to mother, and yet manages to retain her concern for others, which is more than can be said for most others. And second, it reminded me to be humble. If she can go through what she has and retain such care and humanity, what excuse do the rest of us have? Excuses like 'I'm tired' or 'I'm hungry' or 'I'm overwhelmed' mean little in the face of this.
These stories don't have happy endings. But they're as important or more than the success stories. They remind you what is at stake day to day, patient to patient. It would be easy to slip into a detached, mechanical routine. But this field, at its core, is to care for people, not diseases. These stories of loss will hopefully serve as a reminder of that, for at least a little while longer.
I had barely gotten out of the room when I started choking up. Took a detour to the bathroom to compose myself before heading back to the resident room for sign out. I knew rotating through pediatric hematology and oncology would be tough. I tried to mentally prepare myself for it. I think it hit me all the harder cause of it.
I've been at this nearly a year now, and have seem some pretty awful things. One patient I'd been helping care for for three weeks had quickly become my favorite. He and his family were always a welcome and enjoyable stop during pre-rounds or afternoons. His room always had new photos of grandkids, family, or OSU football. He'd made some improvements, but was not making much overall progress. All he wanted was to be home for Thanksgiving with his grandchildren, and have a home cooked meal. A week before, I headed out for the night. I'll see you in the morning, I told him. I came back twelve hours later to an empty, freshly cleaned room, complete with a 'Welcome to The James Cancer Hospital' pamphlet.
Or the time on L&D night call, after having successfully and without complications having back to back vaginal twin deliveries, the team had just sat down to have celebratory Tim Horton's. Right then, the senior got a STAT call to the L&D OR. A patient who 4 hours earlier was happy and laughing with her family with reassuring fetal signs had been rolled back for an emergent C-section. Less than five minutes from the initial incision, the baby was out, handed off to the neonatal team. They immediately started neonatal resuscitation. I held a retractor and tried to ignore the chest compression counts and calls of 'do we have a pulse? No.' In front of my eyes, the mother was having uterine hemorrhage and a flurry of activity was going on to tamponade the bleeding and sew her back together following the traumatic C-section. A midst all this, my gaze drifted to the head of the operating table. His hair was covered with a poorly fitted surgical cap, and his nose and mouth by a surgical mask. All I could see were his eyes. Through them I saw more than I can describe. Loss, powerlessness, paralysis, fear, terror, and more. I'll never forget that sight, that feeling. He wanted to protect his wife and child, but here he was, not only unable to do anything for either, but unable to even understand the chaos that was going on. All he could do was hold her hand. He and mom signed out AMA the next day to go to Children's to spend what time was left with the baby.
Today wasn't the sudden shock of things going wrong. For this toddler, things have been going wrong for a while. She has been in and out of the PICU, having a cardiac arrest with neurologic sequelae, infections and more, on top of a likely terminal cancer. Her prognosis is poor. Her mother understands this. She sees it 24 hours a day, every day. She sees the slow but steady addition of tubes, lines, and other devices. She see the daily blood draws and medication injections. I won't try to make assumptions about her feelings or guess at where on the Kubler-Ross model of grief she is. To do so would trivialize what she is going through.
But I did get a glimpse. A peek at what may keep her going, keep her strong in the face of such sadness and tragedy. As I headed out of her daughter's room, she looked at me, and with a slight smile told me, 'I hope the rest of your patients are doing all right today.'
A mother, who's child is so ill, on the day after Mother's Day, who has so many things on her mind, made a point to ask about the other children. I was absolutely floored. I still am.
Maybe I'm reading into it too much. Maybe she was just being polite. But, this event has so far reminded me of two lessons. First, the strength and resilience of mothers. She is going through the worst scenario that can happen to mother, and yet manages to retain her concern for others, which is more than can be said for most others. And second, it reminded me to be humble. If she can go through what she has and retain such care and humanity, what excuse do the rest of us have? Excuses like 'I'm tired' or 'I'm hungry' or 'I'm overwhelmed' mean little in the face of this.
These stories don't have happy endings. But they're as important or more than the success stories. They remind you what is at stake day to day, patient to patient. It would be easy to slip into a detached, mechanical routine. But this field, at its core, is to care for people, not diseases. These stories of loss will hopefully serve as a reminder of that, for at least a little while longer.
