“If he is hungry when he wakes up, and you don’t let him eat, we’re taking him to another hospital,” the man shouted. I stood trapped between a protective papa bear and his cub. My instinct was to find an exit, but I braced myself for more. This father gave me one last glare before side-stepping around me and wrenching open the door to his child’s hospital room. I glimpsed the man’s profile, as he closed the door quietly behind him so as not to wake his sleeping son.
The patient was a three-year-old boy with a ruptured appendix. He was being made NPO, or nothing by mouth, for possible surgery. Radiologists had read the CT, surgeons had evaluated the patient, and pediatricians stood by analyzing labs and setting up IV fluid schedules. Still, no one knew if, or when, the operation would occur. When the appendix is inflamed, immediate surgery is always required, but after the appendix bursts, there is less certainty about the timeline for surgery. Often a course of antibiotics is needed to allow the inflammation and infection to essentially cool off. The pediatric surgeon promised he would be by later in the day to make a final decision (he was, and the patient ultimately made it through surgery just fine), but for now the boy would need to remain NPO.
The topic of “difficult parents” is one that comes up often in medical school. I have encountered scores of students who swear off the entire field of pediatrics because they find working with families so difficult. The American Academy of Pediatrics also acknowledges the issue, and has published several articles to offer strategies.
While there is no easy answer, it is helpful to think of where these behaviors are coming from. Of course, there will always be those parents who are challenging because they are unhappy, abusive, or apathetic. Still, the most difficult behavior from parents appears to come from a place of intense love for and protection of their children. Particularly when a child is hungry, sick, or distressed, this mama/papa bear behavior understandably escalates.
In front of the pediatric ward at Georgetown, there is a row of wooden benches. These are old, worn down surfaces that, through the years, have served as much more than seats. On my short rotation, I witnessed the benches turn into race car tracks for miniature vehicles, a sketchbook for a bored teenager, and a hiding spot claimed by a giggling toddler. They are a space for reprise for tired mothers and a pew for fathers in prayer. They are a constant reminder for the healthcare workers who pass by that illness affects families, friends, and loved ones; the destructiveness of disease is never limited to one person.
I have no children, and I cannot pretend to imagine I know what it feels like to worry over a sick child. But I can see the pain on parents’ faces, and I have witnessed their fear and grief. I have also seen that distress and frustration directed at the medical student, the nurse, the custodian, and anyone else who may be around. The best advice I have received is to not take it personally, to listen without interrupting, and to understand the underlying protectiveness and uncertainty that motivates the behavior.
While it may seem counterintuitive to stare back at that angry bear and ask if there is anything in the meantime we can do to help, I think it is important to try. It is easy to forget, but at the end of the day, parents and pediatricians are fighting for the same cause: the health and well-being of the child. We sometimes just need a reminder that we are all on the same side.
Natalie Wilcox is a medical student who blogs at the Doctor Blog.
Image credit: Shutterstock.com