No Pictures Tonight

So as most of you know, my current clinical rotation began last month. For the next year (or so), I'll be spending three days a week in the PICU at our local children's hospital. Since the day I began, I've been fielding comments and questions that go something like, "I don't know how you can handle that." For about five minutes, I felt a sense of pride. Look at me doing something important and displaying my professional courage! My puffed up sense of capability was quickly deflated the first time I laid eyes on a dying child. He was probably average sized for his age, but looked so tiny in his large hospital bed with his face covered by equipment. He wasn't a brave little guy battling cancer. He wasn't a child born with the odds stacked against him. He was a healthy, smiling, active preschooler that slipped away from the watchful eyes of his closely knit, church-going, affluent family during a Sunday cookout - and slipped quietly into a swimming pool. He was quickly discovered and pulse restored, but he was gone. I watched his family keep a vigil near his bed for several days. I watched his mom read Richard Scarry books to him and Child Life play recorded messages from his siblings through headphones. I think they all knew the inevitable outcome but it didn't stop them from hoping. Each day, I'd walk by his room and glance through the door to see his mother in the same spot next to him. Then one day, the view changed. I think I felt the air around me literally sucked away as I walked by and saw his empty bed, and his mother, surrounded by the whole family, rocking him in the rocking chair...and I knew. They had to contemplate that thing...that unwelcome thought that we forcefully push out of our minds as quickly as it enters. I realized that day that families like this are courageous. I'm not brave. I'm a voyeur. I have the convenience of choosing whether to stay or go...whether to be there in that hospital or go home to my healthy children. I have the fortune of being preoccupied with school supplies and whether I should buy pants that fit my daughters now, or buy them a bit big to give them room to grow into over the next few months. I have been graced by ability to look at photos of my children and feel enormous pride and affection and not paralyzing grief and sorrow.

I shared the Cliff's Notes version of these thoughts with a friend recently and was asked the logical follow-up question. "So why are you there?" I had no immediate clever answer. I had no good response. I think I forced some trite BS like, "I love having the opportunity to help a family during a crisis." It's not that it's untrue...it's just that there is so much more to it than that. I realized that I am a guest in their lives at that moment. If, during that time, they smile, or offer a sincere "thanks", or they look relieved to see me walk in because I'm someone they trust...I feel like an invited guest. If I can only offer them a parking token or help with an FMLA form, I still feel...useful. I never felt like that in any job before. I felt replaceable. I felt insignificant.

I remember the first time I was in a room with the distraught mother of an adult woman recovering from life-threatening injures from a crash. I was speechless - literally. If you know me, you know this doesn't happen often. I felt ridiculous for being there. It was as if there was a large neon arrow with the words "SHOULD NOT BE HERE" pointing right at me. I just stood there feeling awkward until I remembered the brand new travel pack of Kleenex in my pocket. I remember actually thinking to myself "OH YES!! THIS IS WHAT I CAN DO!" I pulled it out, handed her a tissue, and said quietly, "Keep the pack". She tilted her head to the side and, through her tears, said, "Thank you.". It was as if handing her thin pieces of paper used to wipe snot and other bodily fluids was the most thoughtful gesture she had seen. Although I knew it probably wasn't as significant to her as I perceived, it felt like the perfect thing to do in that moment. It didn't require a profound statement, I had no important paper work, medical advice, or legal counsel. I just handed her Kleenex...and it felt...useful.

I take each day at Children's one at a time. I have deep compassion for the children and especially their families, but I think I've found a unique brand of professional compassion that keeps me leaving in one piece. I will admit that I would like to send out a very WIDESPREAD mass e-mail reminding...no, DEMANDING that people keep their small and/or non-swimmer children away from pools if they aren't within arm's reach, stop shaking their babies, and that mothers choose their children over boyfriends ALL THE F-ING time. But I also keep my judgment closely reeled in - regardless of the circumstances. And to all the families that have answered my questions and politely ignored as I stumbled over myself when trying to do everything perfectly...

Thank you. I don't know how you can handle that.