As I walked into the hospital before sunrise for my rotation in pediatric intensive care, my visible breath in the cold air served as another reminder that winter was here to stay. Winter triggers thoughts of snow, holidays and family. However, for those in medicine, especially in pediatrics, winter and cold weather commonly spark an increase in respiratory illness cases.
As soon as I arrived that morning, a rapid response was called. I ran to a 12-year-old boy who had breathing difficulty. The history of the patient was complicated—he was neurologically devastated from an electrocution accident. At baseline, he needed help with clearing secretions and daily gastric-tube feedings. The respiratory virus he contracted had worsened his symptoms, bringing him to the hospital two days before. That morning, after checking his lines and his active plans, we realized his feeding, which should have lasted several hours, had lasted only one. When we asked who had rushed the feeds, his mother admitted she had thought more nutrition would improve his condition. However, the accelerated nutrition triggered an aspiration event. As the physician team brought the boy to the intensive care unit for additional respiratory support, his mother asked, “Why is he worse? I was just trying to help my son.”
The residents worked like a well-oiled machine to reverse the damage in the child’s lungs. They stabilized him on new respiratory settings and replied curtly to his mother. They verbalized their understanding of the mistake, but their frustration overshadowed their empathy. After we left the room, the residents expressed annoyance at handling an “overbearing mother.”
Later, I entered the room to see the child in discomfort, mirroring his mother’s pain. I asked her if she understood what was going on, and she responded, “Only partly. I just want him to know I am sorry, that I tried to help him.” I probed for more information, and as I sat next to her, she shared some of their story.
She explained the devastation her family felt after the electrical shock accident. Her husband was working more than he ever had to cover the medical costs. The family immigrated to the United States from Egypt, hoping that an American life would ease the navigation of medical care for their child. His mother explained that on Saturdays they walked to the beach in Cape May, and that her son always smiled when they got to the sand. She shared how she had learned to communicate with her nonverbal son and how she waited now for any sign that his condition was improving. She knew that she was not a doctor, but she was, after all, his mother.
After speaking to her for some time, I sat down next to the resident from the morning. Without turning her head from her notes, she said, “You got caught in the path of the overbearing behavior, huh?” I disagreed and emphasized my admiration of her relentless strength.
“In pediatrics, we work not only with children but also with adults—the adults who care for the child when the physician is not there.”
That afternoon, I reflected on this conversation. In pediatrics, we work not only with children but also with adults—the adults who care for the child when the physician is not there. It is easy to become jaded if we don’t know the details that make a child or a family happy and unique. It is easy to stigmatize a questioning mother as overbearing or to accuse a caregiver of doing too much or too little.
This mother taught me to remember to appreciate the value and love of a caregiver. She reminded me to ask the questions that take time. She taught me that it is important to remember that taking care of a child is not just about resolving the pathology. I learned we must probe deeper to expose layers of not just the child but also of the family. She brought back all the reasons why I wanted to be a doctor: to listen, to console, to heal, no matter how that may look.
Every day, I saw the worry on the mother’s face wash away as she observed the growing comfort in her son’s eyes. As I look forward to the end of medical school and the start of a career in pediatrics, I will carry the love of this mother in my heart. On days when I see tragedy, and am overwhelmed by the volume of sick patients, I will remind myself to ask, “Can you tell me more?” I will ask because hearing the answer represents the approval of the patient or family to be an additional caregiver for that child. It is also my duty as a lifelong learner, and it is at the heart of being a humanistic physician.
