I’ve always wanted to be a pediatrician because I love kids; if you ask most people who work in pediatrics whether nurses or physicians they may say that. It’s a very common response to the question “Why pediatrics?” Or how can you do pediatrics?” when students and physicians are asked. Yes, we love working with children for many reasons. Some love the unexpected unrehearsed things kids say; they will shock you, or make your burst out in hilarious fits of laughter. While others love the pliability of children, you can help shape their minds for good. They are impressionable, they are innocent, and reflect hope for the future which is always uplifting. All of these things make working with children a joy.
However, until you have experienced the death of a healthy child, you may not truly understand the work of those in pediatrics. Yes, there is joy; we find that more days than sadness. However, there is very real sadness. The loss of a child is profound. Processing the meaning of a life that has been literally cut short is extremely difficult. Yet we deal with this in our field, from time to time. What I’ve come to learn from my own experience is that pediatricians have a hard time processing this, just like the general population. We are not equipped with superhuman strength; we are not shrouded in a field of protection that deflects pain. We intuitively understand that every outcome will not be ideal, but just like the rest of the world, we struggle with death in our pediatric patients as well. We are actually not wired any differently than our colleagues in other disciplines who deal with grief and loss.
These losses grip your soul and mind; they don’t give you respite. We think about all the potential of the child, how the parents and family must now face reality in his or her absence and we mourn. The most recent loss I experienced of a child with major trauma, I can still hear the mother weeping when I close my eyes. These patients don’t go away. They shouldn’t, and because we are more than just practitioners of care, and these are living breathing humans that we encounter, they don’t.
So how do pediatricians move on? How do we get up the next morning, and continue to do what we do? How do you leave a room where you have declared a code after a valiant effort of resuscitating a healthy child when there is nothing left to be done and move on to see the rest of your busy pediatric ER patients, or continue on your hospital rounds?
Three things pediatricians like other physicians must do to maintain self-care:
1. Say goodbye, we must say goodbye to our patients. This closure can happen in private for a moment at your workstation as you chart, or in your car as you take a deep breath, or in the bathroom stall as you wipe away the tears. You must say goodbye to the human you have encountered for your own peace.
2. Find your source of faith or strength. For many of us that is our religion, for others, it is the interconnectivity of nature and living beings, while for others it is breathing meditation/stillness. It restores their inner strength, peace, balance.
3. Connect with your team. You are not in an emotional vacuum. The loss can feel lonely from the physician perspective. We are taught to be leaders, to be practitioners of wellness. In the hierarchy of medicine, this puts us a distance away from the teams that we lead. Perhaps the nursing staff sits together gives each other hugs, but we stand apart from that. I urge my colleagues to include themselves in those moments. Acknowledge the impact of the moment on you, in the context of the larger team. Your staff will not see this as weakness, but your humanity.
Each time I have lost a patient, sadness remains in my spirit for a time. This sadness is sometimes partnered with anger depending on the circumstances of the death, preventable or senseless. However, I have learned through the years that my role in these critical precious moments is my gift and true honor. As pediatricians, we have the honor of being with our parents, children, families at the peak of joy and in the depths of sorrow. The magnitude of the task and the honor of the work renews my strength. I get to celebrate each first, first steps, first word, first day of school. I get to be with them in their darkest hour of need, in their last hour and death. That is the real joy of pediatrics.
N. Bande Virgil is a pediatric hospitalist.
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