One of the most difficult situations for a parent is one in which your child is sick. To be in a situation where you cannot control how the child responds to interventions is very challenging. Under normal circumstances, you follow your normal daily routine: up in the morning, breakfast, get dressed, off to school or daycare or activities for the day, a nap in the afternoon, pick up from school or daycare, have dinner, take a bath, head to bed. There is comfort in knowing that everyone will follow the routine and, aside from an occasional headache that comes from cleaning up after a spill or someone coloring on the walls, there will not be too much stress above the normal level that persists in almost every household.
Having a sick child can cause a variable amount of change to the routine. A child may stay home from school or daycare and simply require rest and fluids to recover; another may need Tylenol for low-grade fevers and discomfort; still another may have significant symptoms requiring more extensive intervention. Each of these is an interruption to the routine, causing variable levels of disruption. A family may be well-equipped to handle even the sickest children, but others may struggle due to a variety of factors.
As a pediatric resident and a parent of two small children, I am one of a small but significant minority of medical providers who have to deal with a number of challenges associated with having a sick child. First and foremost is having a much broader medical knowledge base than the average parent, but not the same level of experience as an attending physician who may also have young children. To put it more bluntly, as a pediatric resident I have a much stronger sense of what could be wrong, but not enough experience to help me realize that zebras are zebras and that it is unlikely that my child has something more insidious. While no parent can completely rule out the worst, as a pediatric resident it is difficult to avoid perseverating on the worst possible outcome. From experience, I will say that I have put in a number of phone calls to the on-call pediatrician with less than concerning symptoms, just because of what could be going on.
From a more practical standpoint, being a pediatric resident, especially a pediatric intern, provides — to put it gently — some logistical challenges. We are at the mercy of the ACGME and residency program to fulfill the appropriate number of hours, required rotations, conferences, number of procedures. At baseline, it can be difficult to find time to even spend with our families, let alone take the time to focus on them during times of illness. We are especially blessed as pediatric residents in that, on every level, faculty and staff are aware of the importance of family time, but even with that, it can be difficult to even ask for the time to be with a sick child. We must be very deliberate with our use of sick days and time off in order to ensure that this time is available if something far worse happens.
As an example, over the winter my infant daughter, who was 9 months old at the time, came down with a mild case of bronchiolitis. Even without visiting her pediatrician, as a pediatric resident, I was able to recognize the symptoms of congestion, cough, runny nose, poor oral intake, decreased wet diapers and signs of mild increased work of breathing, transmitted upper airway noises with clear lungs (of course I listened to her), tired appearance. I also understood the typical course: that her symptoms would peak around five days, that she’d have a cough for awhile, that the best thing to do for her was suctioning, fluids, and rest. Even with that in mind, I thought about what it could be. Did her cough sound barky enough? Did I hear a wheeze? Does that spot on her arm look like a rash? How many days has she had fever? This exercise made me hyper-aware of any reason to take her to be seen. Around day five of her illness, she had multiple post-tussive emesis episodes, and I felt the need to have her evaluated in the ED. I was reassured that these symptoms were, again, consistent with bronchiolitis, but as a pediatric resident and parent, I still felt as though I needed that extra evaluation to ensure that I was correct in my diagnosis. Although she would later go on to develop an ear infection, which is not uncommon, it was only with continued re-evaluation that I accepted that we were not seeing any of the “worst case scenarios” I had thought up as a pediatric resident.
Logistically, this experience presented a challenge as well. The aforementioned ED visit occurred around 12 a.m. on a Saturday morning, roughly six hours before my weekend call shift in the NICU. I was able to get roughly two hours of sleep in between arriving home from the ED and waking up for my NICU shift, but I felt it important to maintain my shift, lest I put my training in jeopardy. It was only at the request, or rather the demand, of my attending that I go home to stay with my sick child while the flex NNP covered my patients. Again, if I had presented the situation to my attending from the start I likely would have avoided the shift entirely, but in a culture where it can be difficult to convince a resident to stay home if the resident himself is ill, it is even more difficult to ask a resident to take care of his sick child.
For the medical students, a previous experience is also relevant. Even when a child is well and coming home from the hospital, it can be difficult to obtain time to be a parent. As a third-year medical student, my older daughter was born just prior to the start of my core clerkships. She was a premature infant, and this ended up being a blessing in disguise because I was able to visit her every day in the NICU after rounding with my medicine team. When she went home, however, I was required to make up time spent at home with her later in the year. Even asking for time off required a lot of insistence by my family, indicating how difficult it can be as a parent in medical training to feel comfortable asking for the time off.
Ultimately, the point I would like to pass along to my fellow parents, both residents and medical students, is that it is okay to ask for help. Just because the schedule is challenging and the requirements are difficult does not mean that you are obligated to soldier on despite your child having an illness. Asking for help is an important part of being a parent, and it shows everyone that you recognize your limitations and have your priorities in proper order. Training time can always be made up later, but providing support and love to a sick child is ultimately much more important.
Adam D. Langenfeld is a pediatric resident.
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