The following manuscript was submitted to the March 2017 s/p The Match — One Year Later Themed Writing Contest.
Tommy became my patient about halfway through my PICU rotation. He arrived as a transfer from an outside hospital due to concern for liver failure, and on a morning when we already had four admissions, he became another checkbox on my to-do list. As I walked into his room to introduce myself to his parents, I realized that somewhere along the way, in the blur of multi-colored pens, telemetry strips, and endless lists, my patients had been distilled down in my head from people to problems: RSV bronchiolitis, AV canal, pneumonia, and now, liver failure. Checkboxes.
Everything just felt scarier in the ICU. An alarm beeping didn’t mean that maybe someone’s oxygen saturation probe had fallen off — it more likely meant that a child was truly having difficulty with maintaining oxygenation. Ventilators were still a mystery, and nothing about “a routine post-op scoliosis case” felt routine to me. It was okay to be scared. It wasn’t okay that I was allowing myself to move farther away from the type of doctor I’d always wanted to be.
The next morning, I saw my first three patients and then headed toward Tommy’s room to finish my pre-rounding. He had an uneventful night and I figured I would examine him and then start my notes for the day. I walked into his room and found his mom excitedly propping Christmas cards up on the windowsill, his dad pouring Hershey Kisses into a “Kisses from Tommy” bowl that sat on a table in the doorway.
As I walked toward the crib, I started to feel myself slip into a familiar pattern — eyes glancing toward the clock on the wall, mentally calculating how much time I’d have before rounds to start my notes. Tommy was sleeping, pacifier next to him, with a herd of loyal stuffed animals neatly lined up at the foot of his crib. Christmas music playing from an iPhone on the table was punctuated by the rhythmic alarms of his pulse oximetry monitor. Suddenly, Tommy wasn’t a “four-month-old liver failure transferred here for evaluation for liver transplant” but rather a “four-month-old baby boy about to spend his first Christmas in the hospital.” I found myself walking around the room with Tommy’s parents as they showed me their decorations. I saw the Santa Claus pajamas they had bought for Tommy “in case we’re still here in the hospital for Christmas,” I saw the picture frames filled with family photos, and I saw the notebook in which his parents had started writing questions to ask during rounds. More than all of that, though, I saw a family doing their best to maintain some semblance of normalcy, to maintain a little bit of holiday magic, in the Purell-scented, IV-pole-beeping world where they could control so little else.
In the days that followed, pre-rounding on Tommy wasn’t just about assessing his hepatomegaly or tracking his liver enzyme levels. It was about helping his mom choose which Pandora holiday music station to play, about exclaiming over the new baby blankets he had received from cousins, and about his father insisting I take a piece of holiday candy “for breakfast” as I left their room each morning. My morning visits with Tommy became a bright spot during a gray, windy east coast winter, and as I let myself learn to enjoy these moments in the midst of the inevitable chaos, I began to realize that intern year was about not only learning how to be a doctor — but also about discovering the type of doctor I want to be.
Nine months into intern year, I am still figuring it out, and each patient encounter I have is helping me get closer to that goal. Tommy was transferred to a different hospital a few weeks after I met him, but even during the three short weeks I had with him and his family, I learned lessons I will carry with me through intern year and beyond. I’m reminded of him everyday when I write the physical exam section in my progress notes as I try to take an extra moment to personalize the exam in order to show who the child really is — the five-year-old with gastroenteritis is no longer billed as “awake, alert, no acute distress” but is “smiling, drinking a blue slushie, watching a movie in bed,” and the infant seen in clinic for a well-baby exam is not “well-appearing infant” but rather, “well-appearing, cooing, calm in mom’s arms.” It’s a small but tangible thing I can do every day that helps me remember who — not just what — I’m treating, and now, whenever I catch myself getting caught up in the checkboxes, I think of Tommy, his parents, and the Santa Claus pajamas.
Image credit: Christmas DNA by Kevin Dooley licensed under CC BY 2.0.
Resident Physician Contributing Writer
Yale School of Medicine
Sanyukta is a resident physician in pediatrics at Yale School of Medicine.