Updated: Feb 3, 2021
How looking deeper led to greater understanding and boundless compassion.
"Just as a mother would protect her only child with her life even so let one cultivate a boundless love towards all beings." - From the Karaniya Metta Sutta
I was nearing the end of my pediatrics rotation as a third-year medical student when the senior resident asked me to admit a patient to the general pediatrics floor. The only information I had as I headed down to the intensive care unit was that she was a ten-year-old girl who had survived an extensive resuscitation at home.
By this point in my education, I was certain that I wanted to be a pediatrician. I had recently finished my internal medicine rotation. Fresh in my mind were hospitalized patients who were suffering from their past choices, like drug addiction and alcoholic cirrhosis. I had cared for a man who, as soon as he had recovered enough strength, would ask for a pass to go outside and smoke through his tracheostomy. I witnessed the drain on the health care system of long-term patients who required extensive medical and nursing care. I did not feel passionate for a specialty where I would be treating non-compliant adults who chose not to help themselves. At that early point in my career, I failed to understand that addiction meant they could not currently make that choice. I yearned to care for children and to help teach them how to create healthy habits, so that perhaps they may avoid this fate.
I entered a cramped room that was mostly filled by her hospital bed. It swallowed up her small, frail body. She was alone. Where were her parents, I wondered? At once, I noticed that she had a tracheostomy and appeared to be sleeping. Her chart hung at the bedside. Reading it, I learned that she had suffered an event at birth that damaged her brain. She had never walked nor talked. She had been confined to a wheelchair her whole life. One week prior, she was admitted to the Pediatric ICU after a mucous plug blocked off her tracheostomy, resulting in cardiopulmonary arrest. She survived a full resuscitation and recovered, presumably, to her prior baseline.
I felt a mixture of surprising emotions as I looked upon her again. The first of these was a rapid flush of anger. Why? I thought. Why would a patient like this not have a DNR (do not resuscitate) order? Why would one prolong her tragic life? What of the cost to society for her care? What about the cost to her? She may be suffering in some way. What of the cost to her parents and their lives? Was this even ethical?
Anger quickly turned into confusion. I was so at odds with the situation that I suddenly wondered: How could I become a pediatrician? How could I care for patients like this? How could I kindly and compassionately care for her parents in this situation? A sense of desperation came over me as my mind turned over the situation. Would I have to reconsider my beloved career choice? How do all of my inspiring pediatric attendings reconcile this?
Putting the chart down, I took a deep breath and turned back to my patient. The only thing I could think to do was look closer. My anatomy professor taught me this. He was a tough professor who strove to teach deeper lessons. While other students complained about his toughness, I secretly appreciated him for it. Once, during a practical exam on the upper extremity, I looked at a toothpick in a forearm through a small window of plastic, and what I saw did not make any sense to me. I hesitated — was it okay to move the plastic and take a better look? Would I get into trouble? The precious minute I had to identify the structure was running out, so I lifted the plastic to investigate. In doing so, I could see that he had inverted and rotated the arm, and so what I was looking at was actually the opposite side. Right away, I knew the correct answer. I could have guessed based on what was initially right in front of me, but if I had, I would’ve been wrong. His point was twofold and well-taken. You have to learn to listen to and trust your own clinical intuition. If something doesn’t seem to fit, it probably is incorrect and you must look closer, gather more information, and keep searching until you are confident you have the best answer.
Her eyes were closed, her face calm. Her lips were dry and cracked, and her unused teeth sharp and yellowed with plaque. Her tracheostomy bubbled noisily with saliva. It was then that I noticed her soft blonde hair. Her mother, I presumed, had plaited it into two perfect French braids. Not a single strand was awry. Each braid ended in a delicate, lacy, pink ribbon tied into a bow. Then her hands — each dainty, tapered finger — ended in a perfectly manicured nail, lovingly painted a shade of girly pink. It dawned on me unexpectedly — this child means something to her mother. Despite her condition, she means the world to someone — her mother, her father, her extended family. Suddenly, I understood. My fears that had gripped me just moments before vanished. I suddenly became aware that I had no frame of reference for this. I was not yet a mother, much less a mother of a medically complex child. In that moment, I clearly saw the reality of truly caring for patients, no matter what their circumstances. I was flooded with compassion. It was in that moment — not when I later graduated from medical school — that compassion was born, and I became a physician.
Now after so many years of practice and motherhood, I see every single patient in a fresh light. Each one is precious, regardless of their choices or situation. My work has become fulfilling in immeasurable ways. A child who never spoke, walked, or was cognizant that she was alive gave me a precious gift that I try my utmost to give back to each of my patients in turn: a capacity for compassion that is boundless.
Reprint of an article I originally wrote in 2017.