While on inpatient pediatrics, I helped care for a young boy admitted following urological complications after surgery. I first heard about him during morning sign-out: he was in severe pain, and his Foley catheter kept getting clogged and needed to be flushed repeatedly. As I scribbled down his most recent vitals and labs in preparation to see him, I realized how nervous I was. I had yet to see such a young patient in such intense pain. I could hear him crying from down the hall, and as I walked to his room, I rehearsed my usual greeting in my head to make sure I could introduce myself in as non-threatening a way as possible.
“Hi, is this James in here?” I asked, in a voice even softer than normal, to the woman seated next to the young boy. “My name is Linda and I’m a medical student on your son’s care team. Is it okay if I ask a few questions?”
James’ mother furrowed her eyebrows and hesitated before speaking, but she took my hand and said yes. James had stopped crying since I entered the room and instead assumed a look of terror.
“Please don’t touch me down there!” he shouted.
“I won’t, I promise — is it okay if I just talk to you and your mom really quick?”
He reluctantly nodded his head and wiped his tears.
“My first question: you don’t like animal stickers, do you?”
He answered with an emphatic “Yes, I do!” and perused my stickers before picking out a tiger. He continued to dig through the rest of the stickers, and I sat down to ask his mom about the surgery and his symptoms since then: if he was eating and drinking well, if the pain seemed to be getting worse or better. His mother was concerned. She told me what had been going on and asked me a few questions to relay to my team.
When it would have been time for me to start the physical examination, I fished for the monkey finger puppet in my pocket. I turned to James, asking him to follow the monkey with his eyes. He did. I asked him if I could listen to his heart and lungs, and again promised I wouldn’t touch him “down there.” He shook his head and looked frightened. I told him I hoped he started to feel better soon and said goodbye to him and his mom. As I began to exit the room, a volunteer came in with a therapy dog, and James’ face lit up immediately. I was disappointed that I hadn’t gained James’ trust enough to examine him, but I was overjoyed that something put a big smile on his face.
During sign-out the next morning, the overnight team said the urologists had seen James and his catheter had been clogged again. His mother requested that only attendings — no residents or medical students — see James: he was in too much pain and very frightened. I was sad to hear he was still in so much pain and also disappointed that I wouldn’t have a chance to see him again. I thought back to my visit with him and his mother the day before and wondered if there was anything I should have done differently to put them more at ease.
Over the past several weeks, I have combed through my encounter with James and his mother countless times. I’ve wondered what else I could have done: spent more time speaking with his mom, given James more stickers, refrained from asking to listen to his heart and lungs once I promised not to touch him. I probably could have done a few things differently to make James and his mom feel a bit more comfortable. But I’ve come to the conclusion that I could have done little to improve their entire experience of the pain and anxiety that came with the hospitalization.
As an individual member of the care team, I could not change how much pain James was in, how many others came to examine and prod him, or how other medical professionals made James and his mother feel. No matter how hard I try, my single encounter with a patient cannot always change their experience with illness. This realization provided some relief from a feeling of overwhelming responsibility. It was also disappointing, because it necessarily presupposes that I will not be able to make every patient feel better. Altogether, it has helped me regain my focus on what I can impact: my own encounters with each patient and family I see, and the thoughtfulness with which I approach them.
Even though I could no longer see James, I called volunteer services later that day to see if a volunteer dog could visit him. That was the only thing that had seemed to get his mind off his pain. The volunteer had already stopped by, and James had been away from his room. I asked them to pay him a special trip. I didn’t see James again, but I’m hopeful I did my best for him.
Author’s note: Names have been changed to protect patient privacy.