The Most Difficult Month

My first patient funeral was for a 2 month old baby boy. He had a severe congenital heart defect that would be fatal, and the surgery required to fix it was also risky. His parents opted for the surgery, and after a long attempt at recovery post-operatively, he passed peacefully in his mothers and fathers arms. The funeral was beautiful and full of life. The focus wasn’t on death or grief, but instead on how much joy he brought to everyone around him. The pastor said something I don’t think I’ll ever forget. “Most 80-year-olds I’ve seen don’t have half this many people at their funerals. It seems this little one touched more lives than most of us can ever hope to… and maybe that was his purpose.” It was a deeply moving service and the family shared many home videos that made it all the more meaningful. I won’t soon forget this little boy or the privilege of getting to meet him during his short life.

I just finished my Pediatric Intensive Care Unit rotation (PICU… pronounced “pick-you”). I saw more heartache in this one month than all of my other rotations combined. That’s probably a large reason why I’ve put off writing this post… while it’s therapeutic for me to blog, it forces me to reflect. And sometimes, when you’ve seen some horrible stuff, it’s easier to ignore it and pretend like none of it happened.

Another moving story was a drowning patient I saw. She wasn’t even a toddler yet. She was brought to our unit intubated and on a ventilator, and her MRI didn’t show much hope. The background story is too horrible to share here, but basically it was a terrible accident that threatened to ruin this family. After 4 days in the hospital and no clinical improvement, her family decided to withdraw care. The Attending taught me to do a brain death exam- something very important to learn, but heartbreaking no matter who you learn it on… I never thought I would be learning it on a baby. The exam involves looking into the patient’s eyes. I will never, ever forget how beautiful this baby’s eyes were. Perhaps the most difficult moment for me was pulling her breathing tube out and handing her fragile tiny body to her parents to hold one last time. We then were left standing outside the room, watching the heart monitor to assess her precise moment of death, and listening to her parents say their goodbyes to their baby. It was by far one of the most painful days I’ve ever had. A small comfort was that the Attending and nurses were all crying with me. It’s nice to know that we never “get used to it” and situations like these never become “easy.” I asked my Attending how he ever gets through cases like these. He told me “there’s a good way and bad way to do these tough exams. The way to make it through is to make this terrible situation a little easier on the family by doing it the good way. That way, you helped at least a little bit. You may not know it, but they’ll always be grateful for that.” What great advice.

The month wasn’t all bad though! It was like God knew what I needed to cope. There was a small chapel with a prayer book on the PICU floor and I made it a habit to visit it daily, a sort of personal “debriefing” session. I also had the opportunity to start playing oboe again- one of my outlets for my emotions/frustrations in life. I realized on this rotation that, yes, the losses are the MOST devastating of any rotation I’ve been on yet…. But the wins, the good stories, and the kids-who-get-to-go-home stories are the MOST rewarding I’ve ever seen.

I told my Attendings I was interested in Peds and Anesthesiology- so they gave me as much OR time as possible. I saw a bilateral Morgagni diaphragmatic hernia repair (having 1 is rare.. have BILATERAL is unheard of!).  I got to see a total repair of Tetralogy of Fallot- a rare congenital heart defect resulting in 4 (tetra-) anatomic changes. The surgical field on this baby was the size of the top of a soup can! The baby’s heart was the size of a walnut. The surgeon was using hair-like suturing material to put stitches everywhere he needed to. It was so delicate and so incredible to see what medical technology and the skilled hands of a surgeon can do. It was even more amazing to see the baby wake up the next day and go home 6 days later!

PICU is fast-paced, hands-on, and super interesting. I saw a 1 year old code on the floor & saw the physicians bring him back to life in front of me & go home the next day. I saw an 8 month old code on the operating table & the anesthesiologist temporarily stopped her heart with medications to allow her to recover. I saw medical diagnoses on this rotation that I’ll probably never see again in my career. THAT’S how rare some of these diseases are. So, medically and intellectually, it was the most interesting rotation I’ve ever been on! For HIPAA reasons, I can’t even post the names of some of the disorders/syndromes/diseases I’ve seen, because they’re literally the ONE case in the USA in the last 10+ years… so it would be obvious which patients I was talking about! That stinks, but also it’s really stinking cool I got to see them. If I pursue pediatrics, I could easily see myself doing Peds ICU. It is very similar to anesthesiology in that doctors have to think on their feet, get to do small procedures, and get to put their energy into handling a few high-intensity cases at a time.

My first & third week, I was with the same doctor. My second & fourth weeks I was with 2 different Attendings. I enjoyed getting to work with 3 different doctors, but it often made it confusing week-to-week. My first doctor wanted me to follow him around and see all of the patients with him & ask him tons of questions. He told me I was the best student he’s ever had. The second Attending wanted me to be more independent and take 2 patients of my “own,” and meet him daily for a formal 20-minute lecture. The Attending I had my 4th week wanted me to take 3+ patients of my “own” and spend all of my time reading/not asking questions. This last doctor was tough, because I always felt like I was failing to impress her/meet her expectations. Constantly changing doctors made it tough to follow and I was exhausted by the end of the rotation. They asked for my feedback on my last day, and I told them honestly I wanted more consistency and an outline of exactly what they expected. No student should feel they’re failing to meet one Attending’s expectations, especially when their Attending last week said they’re the best student they’ve ever seen! I was worried about my evaluation- third year of med school our grade is made up of our post-rotation exam plus our evaluation score…. fourth year our grade is ONLY our evaluation, so doctors can really tank your grade easily- but my “tough” Attending gave me a perfect score and only had good things to say about me. Sigh. Of. Relief!!

All in all, this rotation stretched me beyond my capacity in more ways than one. I was challenged emotionally, intellectually, spiritually, and physically. I feel so honored that I got to see so many interesting patients and so blessed I got to know their families and be a part of their intense ICU stays. Most of my Attendings were awesome too and taught me a ton about what it means both education-wise and career-wise to be a Pediatric Intensivist.

These are the tiny humans. These are children. They believe in magic. They play pretend. There is fairy dust in their IV bags. They hope, and they cross their fingers, and they make wishes, and that makes them more resilient than adults. They recover faster, survive worse. They believe.

-Shameless Grey’s Anatomy Quote that fits this month’s rotation perfectly

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One thought on “The Most Difficult Month

  1. your skillful mix of fact perception and wit make for another roller coaster post. Having been the mom in the PICU I can only say once again how lucky the families are that are placed in your hands. Your mix of focus, intelligence and hard work are my privilege to see turn out another healer to the world. Grand Pa Charlie is watching and his smile is bursting !!!
    LYSM Merry Ma

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