St. Louis, Missouri, United States (Fall 2013)
Never underestimate a medical student’s capacity for worry. Whether anxious about an upcoming exam or beginning a new rotation with a curmudgeonly attending, no one makes it through medical school without having to battle these existential butterflies. I found this to be especially true while I was on a pediatrics rotation, soon after learning that I was going to be a father. After seeing that innocent pink plus sign, worry became a part of the daily routine, complete and irrational worry. Is the pregnancy developing normally? Could my wife’s recent cold be an unusual presentation of rubella? Will she get sick from petting that kitten, or from eating that lunchmeat? Is it okay that her morning sickness has disappeared? Why doesn’t she look more pregnant? Sometimes it is hard to believe that pregnancy and childbirth ever work according to plan.
Add to these worries the images of sick children that filled the rooms of the pediatric hospital on a daily basis: cystic fibrosis, spinal muscular atrophy, congenital heart defects. Every day, another face with another disease reinforced the improbability of life and the irrationality of disease, pushing worry towards paranoia. Some say that every medical student must go through a thing called nosophobia, or medical student’s syndrome, where we invariably diagnose ourselves with any number of the diseases that we study so in depth. (Personally, I have been self-diagnosed with tuberculosis and a brain tumor during my brief medical career, only to be set straight by the restrained chuckle of the physician with whom I shared these concerns.) I would propose that the next logical step in this progression of psychosis is feto-nosophobia, the persistent urge to irrationally diagnose diseases in one’s unborn child. Working in a pediatric hospital with this syndrome is like sending an alcoholic to bartending school. Temptation is everywhere, eating away at your resistance.
Despite my reckless imagination, however, I have come to realize that most children in the hospital are not desperately ill. In fact, most kids go home relatively quickly, and in better shape than when they first arrived. After all, bronchiolitis and asthma always top the lists of admission diagnoses, and these children routinely get better. With this realization, and with my wife looking more and more pregnant each week, my case of feto-nosophobia is slowly remitting, one day at a time.
As I regain my grasp of logic, I am beginning to turn my attention from the children in the hospital to the parents. While their children are being treated, even for routine problems, parents continually have their patience and resolve tested. Stressed-out, sleep-deprived, and sore from sleeping on a makeshift bed in the patient’s room, these parents provide relentless, unwavering support to their children, sustained by the seed of parental love that is planted before the birth of a child. Drawing from this hidden source of strength, I have seen parents handle burdens greater than they should be able to bear. Case in point: a father whom I will call “John.”
John was a burly man with tattoos spreading up and down each thick forearm, the sort of man who could blend in at any biker bar. His deep voice and gruff demeanor could easily intimidate anyone he encountered, that is anyone except for his four year old daughter. We will call her “Hailey.”
Hailey was admitted for severe constipation. She had held in her stool for too long, and now it had become impacted. Nearly two weeks had passed since her last bowel movement. As I explained it to the family, we had to “pump her full of a special liquid to flush all of the poop out.” We pumped in five liters through a thin rubber tube in her nose before she finally started to clear out. As we continued to pump, she continued to poop, but the stool was not clear enough. She needed more fluid and more time. Things continued smoothly until she gagged and coughed, sending the rubber nasogastric tube flying out of her nose. I could see the fear and anger in her eyes when I said, “We need to replace the tube, but don’t worry. It will be easy-peasy.” Little did I understand the obstinacy of a frightened child.
The moment I removed the new tube from the sterile packaging, Hailey’s eyes locked onto my hand. She glared at me as though I were death incarnate. Any rapport that I had developed with her had vanished in an instant. I tried to speak softly, to reassure, to explain, but all she saw was the tube. When I took a step towards her, she clamped her hands over her nose, blocking the path to her nostril. I tried to move her hand, but she grabbed her face even tighter and let out a blood curdling scream. She was stronger than I thought any child should be.
Her father came to my aid, taking the girl into his lap and hugging her tightly. As he pried her arms away from her face, I had a shot and I took it, lunging tube in hand towards her nostril, but she got an arm free and swiped furiously at my hand. I pulled back momentarily, then went in for the second attempt. Her tiny hand got free again, this time grabbing her father’s thick neck and digging deeply.
“Sweetie, you’re choking me!” he rasped. He repositioned her in his lap and offered soft reassurances as we tried one final time. She thrashed and screamed, but I felt the tube slide gently through her nose and esophagus, finally landing in the stomach. Just as the tube reached its final position, she let out a red-faced scream and the floodgates opened. The last liter of polyethylene glycol in her intestines suddenly burst free, spilling liquid stool around her diaper and soaking through her father’s clothes, leaving a puddle on the floor.
“Oh my God! Sweetie, you just pooped on me,” he yelled in disbelief. Despite the smell, his look of horror turned into a full-throated laugh. “You pooped all over me, baby.” Her tears stopped and they both laughed as he gave her a hug and kiss.
As I move closer to becoming a pediatrician and a father, I am just entering the business of getting “pooped on.” I will become the sleep-deprived and stressed parent. I will listen to annoying children’s songs in the car instead of Led Zeppelin. My house will never again be as clean as it is now. My priorities will change forever. And someday, I may find myself sleeping on an uncomfortable, make-shift bed in my child’s hospital room. But I will survive these challenges just as I will survive feto-nosophobia, and just as innumerable other medical students and parents in the past have survived. I will do so by leaning on the tree that sprouts from that tiny seed of love, planted in our hearts as we wait for our children to be born. Although life is improbable and disease is irrational, great things come from tiny seeds.
BRYAN SISK, MD is a pediatrics resident at St. Louis Children’s Hospital, and a recent graduate of the Cleveland Clinic Lerner College of Medicine. He is pursuing a career in academic pediatrics with the goal of interweaving the humanities into medical education and clinical practice. His undergraduate training was in biochemistry at the University of Missouri—Columbia. He is an avid musician and writer, and is author of the book “A Lasting Effect: Reflections on Music and Medicine.” Additionally, he was the founder and editor of “Stethos: Medical Humanities Journal of CCLCM,” and also serves as deputy editor of “The Living Hand” humanities section for the Journal of General Internal Medicine – Web Edition. His prose and poetry has been published in several journals, including The Examined Life, Hektoen International, Yale Journal for the Humanities in Medicine, Burning Word, Texas Heart Institute Journal – “Peabody’s Corner”, Journal of General Internal Medicine, Miser Magazine, and Stethos.