Events that Shape Us in Medicine

There are many events in our career that shape who we are and who we become as a physician. Nevertheless, there are some that stand out more than others. These events may be so profound that we can relive them in our minds. We see and feel every detail like we are experiencing it all over again. I had one of those events in my medical school training.

As a third-year medical student, I was on my clinical rotations. The clinical rotations were where medical students gained exposure to different specialties in medicine…surgery, internal medicine, psychiatry, pediatrics, etc. I was on my pediatric rotation and I was enjoying it. I didn’t know if that was what I was going to pursue as a medical career at the time, but I was taking it all in.

I followed the clinical care and rounded on a number of patients on the pediatric hospital ward. There were a number of different children who were admitted with a variety of diagnoses and I felt like I was learning a lot. However, one patient was going to disrupt my routine and relatively uneventful pediatric ward experience. I can’t remember the exact diagnosis or issue, but she had undergone an orthopedic procedure and was in a special cast that immobilized her hips and legs. She was about 5 or 6 years old and was recovering on the pediatric ward, after her procedure. She was doing well.

As per my routine, I visited all the children that I was following on the rotation. I would review the labs and radiologic studies. I talked with the bedside nurses and asked what events occurred overnight. I collected the vital sign ranges, dietary and fluid intake amounts, volume of urine output, and number of bowel movements for the last 24 hours for each patient. Along with my findings on my exam and the information collected, I would report my clinical assessment to the pediatric resident and attending who were the leads on our team. Then, I would generate the care plan for the day. This routine was repeated day after day during the rotation. We accepted new patients to the ward and discharged others. There was a steady flow of hospitalized children needing care for various things and we were working hard to provide the best care that we could.

One morning, I arrived at the hospital and started my rounds. I was visiting the rooms of the kids that were on my rounding list and obtaining all the information that I needed prior to starting rounds with the team. As I walked up to the room of the little girl who had the orthopedic procedure, I noticed the room was empty. It was unexpected because we had not discharged her home and I was fully expecting to see her there. I had no clue about what happened to her, so I asked the nurses at the nursing station where she was. With visible unease, they explained that she was taken to the pediatric intensive care unit (PICU). At this point in my training, I really didn’t know what that meant and had never stepped foot in the PICU until that day.

As I worked my way to the edge of the pediatric ward and looked at the imposing mechanical, metal, double doors that separated the regular ward from the PICU, I was uncertain about what I would find and definitely not prepared for what I would see. I stepped through those doors and entered into a completely different world. One world was routine, fairly mundane, and uneventful. The other world was completely the opposite. More than just seeing the visual cues of the transition, as I stepped through those mechanical, metal, double doors, I could feel the difference in the environment like I was stepping out of the comfort of my home and into the cold air of a winter morning.

The scene that I walked into could not have been more emotional or catastrophic. I asked the medical team what had happened to her and found out that she had unexpectedly passed away overnight. I was shocked and in disbelief. However, I was not nearly in the same condition as the family and parents. As I turned toward the room in the PICU where they were sitting, I could see them motionless like statues and staring straight ahead at no fixed point in the room as if they were looking straight through the walls. To this day, I cannot fathom the grief that they were experiencing. But, after my years as an attending in the PICU, I have seen that same look many times, unfortunately. The look of losing a child.

As I ventured to the room in which they sat, I didn’t know what to do. I didn’t know if I was welcome. I didn’t know if they wanted me there. I didn’t know what to feel or what to say. I just sat down with them and said nothing. I had spoken with them on many occasions during my rotation. But, I just could not build up the courage to say anything. This was something that I was not prepared for. But, I guess one never is…no matter how many times one experiences death in the medical field.

At that moment, I didn’t know if I could go into pediatrics as a career and I definitely didn’t ever think that I would journey into the field of pediatric critical care medicine. I was just trying to cope with what I had just experienced. Fortunately, for me, there was an amazing pediatric chief resident who sat down with me, one on one, and helped me process what had happened. I will forever be grateful to him and for what I learned that day. While it was painful for me, it was nothing compared to what the family experienced and I would never pretend to understand the depth of their grief. Yet, it had such a profound effect on me and I have carried the experience with me to this day as part of my own narrative. This was my first experience with the death of a young child and I feel that it contributed greatly to shaping who I would become as a physician over the following 3 decades.

Do you have an event or person in your career that helped shape who you would become in medicine?