The unexpected impact this patient had on his pediatrician

As a pediatrician, I work to keep children healthy so they can grow up and achieve their dreams. Occasionally, my naïve optimism has gotten the better of me. I especially have a soft spot for angry, defiant children. These children are given my undivided attention and respect, and I expect the same in return. I never call them names, insult them, or label them. On the contrary, I have high expectations and am always encouraging them to be their best selves. I often hug them tight as their anger gives way to tears, reassuring them as much as possible.

A decade ago, I took care of a blended family with three children by three different fathers. The oldest boy, Bobby (identifying information changed), was an “angry” seven year old with wide eyes and an endearing, crooked smile. His mother was exasperated and demanded tranquilizers be prescribed to him, or she would switch physicians. I asked Bobby what was going on. He talked about conflicts with his mothers’ new boyfriend and how he resented this man calling him lazy and stupid. He had tears in his eyes, which broke my heart.

I talked to him about ways to deal with his anger and recommended a nearby family counselor. I hugged him, acknowledged his frustration, and told him he was neither lazy nor stupid. I reminded him to never give up on himself, and no matter what happened, I would always believe in him. Needless to say, his mom changed physicians, and I did not see Bobby again.

When children enter the juvenile detention system, they lose Medicaid insurance coverage. As a result, I was the consulting physician at our local juvenile facility. I cared for children who were addicts, thieves, vandals, and committed a variety of other crimes. I reviewed their health history, updated immunizations, and prescribed medications when necessary. It was difficult to reconcile my job as a physician looking into their eyes and seeing their fear, yet knowing I could do nothing to alleviate the obstacles they faced.

My toughest day was the one when I unexpectedly ran into Bobby. I had been consulting over the phone with the RN at juvenile hall on a teenager who sustained injuries during arrest by coordinating care with a local specialist. Over the five day time period, I never asked his name.

Each week, I drove to juvenile hall to sign orders and examine children when necessary. That day, I came upon Bobby’s chart.

“This is my injured boy? I know him.” I declared. She smiled and replied, “He said you were his doctor when he was little, and he is excited to see you.”

As the guard left to get Bobby, I told him, “Be prepared. I am going to hug this next one like he is my own son. I do not care what he did.”

The guard gave me a funny look as he sauntered away. I had thought of Bobby so often over the years, yet had the sinking feeling things had been far from rosy. As Bobby walked through the metal double doors, I was struck by how much he had changed in both size and stature (now well over 6 feet tall). We hugged as if no time had passed: “Bobby, you are so much more grown up than I remember.” He smiled with that same crooked grin I found so endearing a decade before. “You are so much tinier than I remember,” he replied looking down at me.

Over the last decade, his mother and her children moved multiple times, had done their fair share of couch surfing, and Bobby had been suspended for misbehavior and truancy. A few months before his arrest, his mother kicked him out, he moved back to the area, was stealing, using drugs, and suspected his 17-year-old girlfriend was newly pregnant.

Crestfallen, I almost started crying, then and there. My dreams for this young boy from ten years ago were shattered into tiny little pieces. In my mind, at the tender age of seven, he had been a ball of clay ready to be molded into something beautiful. Instead, all hope had been extinguished from the young man who stood before me now. There was no sparkle in his eye; the devilish grin was all that remained of that innocent child I once knew.

Honest to a fault, we talked about lost opportunities and lasting consequences of his poor decisions. I encouraged him to dream of a future outside of prison walls. I reminded him of how kind, warm, and genuine he was with a great deal to offer the world.

Unprepared for my own feelings of sadness and disappointment, this experience hit me unexpectedly like a ton of bricks. I have yet to recover the abiding faith that all children can achieve their dreams. It has been an extremely tough lesson to accept; yet it reaffirmed my commitment to continue encouraging, loving, and supporting each and every child who walks through my doors and into my heart.

While I do not know where Bobby is today, I hope our brief encounter had as profound an impact on him, and he did on me. Kiddo, I think of you every day and hope you are safe, know you are loved, and remember you have much to offer the world.

Niran S. Al-Agba is a pediatrician who blogs at MommyDoc

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