I sat down at the computer and began reading about my assigned patients, as is expected after morning hand-off in the inpatient pediatric wards. My first patient was a ten-year-old boy with a history of tethered cord syndrome, which incited a multitude of other neurological sequelae, who was status post his second corrective spinal surgery. While delving into his chart and reading past notes, I could not help but to be overcome by sadness and heartache. This boy and his family seemed like they pretty much lived within the hospital. So many procedures, so many subspecialists involved in his care, so many admissions and prolonged inpatient stays.
As we were not allowed to see patients prior to rounds due to Covid-19 restrictions, I prepared my oral presentation for morning rounds as best as I could– complete with overnight events, vitals and recent labs, and my assessment and plan which mainly focused on post-operative pain control and close coordination with physical therapy in order to assess patient mobility. In my head I wondered what the patient looked like, and if or how his attitude and morale were affected by numerous hospital stays.
Rounding seemed to pass slowly as I anxiously waited to practice family-centered rounds in front of a patient and family members I had never met before. Finally, we reached his room in the PICU. I knocked on the door and walked in, the leader in a train of other students, nurses, residents, and attendings.
“Hi,” I exclaimed, genuinely excited, “It’s great to meet you!”
One by one the medical team introduced themselves. I then took a deep breath and began my presentation. I was just about to report that the patient had been afebrile overnight when I was suddenly interrupted.
“I’m going to call you Smiley,” said a small voice.
I looked up and realized it was the patient that was speaking to me. Forgetting all about my presentation, I crouched by his bed.
“Smiley, huh?”, I teased.
With a little grin on his face, he continued, “Well, so many people come in here every day, and I can’t remember everyone’s name. So yup, you are Smiley!”
“Well silly, you can’t even see my smile with this mask I have on,” I said.
He shrugged and said nonchalantly, “I can tell you are smiling by your eyes.”
My heart swelled, and I felt my throat begin to tighten as I tried to maintain my composure.
“Well aren’t you just the biggest sweetheart?”, I said, looking towards his mom.
I think about this interaction a lot. It is one that I truly believe will always remain ingrained in my mind. I had entered the room half expecting a defeated child, visibly beaten down by yet another hospital visit that kept him from living the life of a “normal” ten-year-old. Instead I encountered a cheeky, little fellow with a heart of gold that in many ways turned out to be the most intelligent person in the room.
Upon leaving the PICU, a poem by Robert Frost titled “Stopping by Woods on a Snowy Evening” crept into my mind. When dissected, the poem speaks of a man traveling in a rush, with many matters to attend to. This man takes a moment to pause, despite a fast track world of progress urging him to do otherwise. He pauses with such intent that he is able to hear the sound of falling snowflakes.
As a future pediatrician, I sincerely believe that us adults, us doctors, have much to learn from children. This child,who so endearingly nicknamed me “Smiley”, had grown up spending most of his life in the hustle and bustle hospital lifestyle, and yet he took a moment to pause and recognize kindness and good intention. In doing so, he urged me to pause, abandon my rigid patient presentation, and do the same.
As a fourth-year medical student 6 months away from embarking into the structured chaos that is residency, I now realize how important it is to pause. Medical school was hard and busy. Residency will be harder and busier. What I fear most, is that while engulfed in this world of “hard and busy” I will forget why I was called to medicine, and more specifically pediatrics, in the first place. The remedy to this affliction is quite simply, an intentional pause. We must pause and treat ourselves with grace during a day that seems tumultuous and invincible. We must pause to celebrate the small wins. We must pause to reflect on children that unknowingly make our hearts burst, unknowingly reinvigorate our spirits, with something as simple as a nickname.