when children die: why I chose pediatrics
It’s the constant question asked of all medical students:
“So, what kind of doctor are you going to be?”
I batted around this question like a boxer, left hook “Maybe Obstetrics for the procedures,” right swing “Or maybe psychiatry,” and the upper cut “I like adults and kids, so maybe Med-Peds.”
I dwelt on the combined residency program, Internal Medicine and Pediatrics, for quite some time. Mostly back in May when I had the opportunity to present a case I helped diagnose while I was on Internal Medicine (shitting my pants also because FREAKIN grand ROUNDS.....UM whoa). The thrill of the diagnosis and the vast array of knowledge from the pre-clinical years of medicine that were applied. It felt like betrayal to let it all go and I did and still do enjoy seeing adult patients.
There were many so called epiphanies where I thought “AHA, yes I will do just Pediatrics,” and then not 3 hours later I was second guessing and considering. Ask anyone. This happened at least 4 times in the past 4 months. At least 2 of those 4 were in August, right before ERAS submission time. I almost wrote two full personal statements.
The tables really turned during my Geriatrics rotation. I had just done Pediatric Infectious Disease, my Sub-Internship on General Pediatric Wards. I felt like I would be a strong pediatric hospitalist. And then I stepped in to the Geriatric clinic. These wobbly, stubborn, glassy-eyed patients strongly resembled infants. Except they had such amazing stories to tell. Scuba-divers, military personnel, innovators, the whole gambit. I could sit and listen to them for ages. They encouraged me in my endeavor to become a doctor. They taught me so much about grudges, forgiveness, loneliness, and contentment. I loved them. I thought... Med-Peds it is.
As part of our Geriatrics rotation, we spend one week with the palliative care team. Their cozy call room is shared with the pediatric palliative care team, which used to consist of one physician assistant and recently grew to include an attending. I spent one day with adult palliative medicine and the rest with the pediatric team. It was hard to see people’s fathers, great aunts, and uncles suffering. The care in the sub-acute floors is run by outside, community physicians who spend a grand total of 12 minutes on 27 patients with copied notes (don’t get me started on the ethics of that). No one would want their loved-one to die like that... with that type of care.
But what did me in was the deceased list.
My first day with the pediatric palliative care team, they printed a list for me. The last 4 names were the patients who had recently passed away and the attending was planning to write their families cards.
I knew 2 of those names. Two weeks earlier, they were my patients on pediatric infectious disease. Lung transplant, 15-year-old with cystic fibrosis. Heart transplant, 2-year-old with congenital heart defect. The teenager had begged to be extubated. Begged.
When I’d last seen him, he was sitting up in bed talking about high school and playing his Nintendo Switch.
That’s when I knew. I knew I would become a pediatrician.
His story, her story, they won’t get to grow old and tell them. And my stomach sank, heavy with leaden sadness, wishing I could have seen them again. That the little girl with the heart transplant didn’t have this gash of medical drips and beeps and tape and tubes slathered across the end of her story.
I want to meet these kids again. To tell their stories even as they end. I loved hearing those elderly folks stories, because they started as little ones. And those are the great beginnings and ends I want to be a part of as a pediatrician.
