in review

Pediatrics was my introduction to life in the hospital, and while it gave me time to cook and exercise and spend time with my friends over dinner and at the beach, finding balance still meant too tired at night to flesh out the day. So as inadequately as usual, some snippets of a wonderful four weeks working with school age children (spanning ages five to eighteen, though the highest I personally got was thirteen).

*Getting personal with swine flu: It was splashed anywhere our eyes and ears fell upon, and overexposure created distance. It's true that it's not much different from your annual winter flu, but it gave me a chance to see its effects during a summer rotation, out of its usual season. "Asthma exacerbation secondary to swine flu" sometimes made up a quarter of the hospital admissions while I was there, and it was my first patient. Heard real "crackles" in the lung for the first time (sounds like undoing velcro). Flu is inconvenience for most; for asthmatics it means being confined to a hospital room where people come in and out armed with a gown and gloves and strapped with a respirator mask, a mouth mask, and a face mask.

*Listening slowly: A patient with chronic pain, in the hospital for an acute episode, was my foray into this world of subjective disease and healing. I learned that one way to measure a pain is whether a person is "easily distractable," and learned that distraction is a two-way street. My sickle cell patient read aloud deliberately and slowly. So slowly that I lost track of sentences and just heard words. She decided she didn't like two books after a few pages; she did finally like Nancy Drew.

*Witnessing what's worthy: I never found a way to the feverish little one, who was seen by so many different doctors and nurses and random people like me. Politely answered my questions, politely refused offers of games, always said he was feeling good, in between and during fits of cough and sputum. But he lit up for his older sister, my age. His sister who stayed nights with him and left at six in the morning to commute to her job a couple hours away, after having left a detailed note about where she left his Taco Bell leftovers and full of thanks for taking care of him. Who was so happy to see him improve, happy maybe more ingenuously than anyone I've seen. When I told him he was lucky to have such a sister, he looked at her, smiled a slow crinkle of lips, and said I know. How many kids know, how many grown-ups really know.

*Finding the elusiveness of observation: So many of the kids we saw had been through so much, for so little body grown and so little time lived. Being impressed by their toughness became quickly ingrained, such that moments of outright vulnerability surprised me, and reminded me to let things show themselves and to consider them as they did. Hearing a little girl say she was scared, pulling her hand away from the IV, hearing her dad talk about not wanting to put her through another sedation, stood in my mind beside the images of her walking steady and holding her head firm, despite physical oppositions--I was pulled back to what was there, reminded to be open and not escape into all else that had formed.

*Gathering more and more respect: I admired one resident's natural cheerfulness through sleepless nights and ease of humor, another's tough efficiency and caring demeanor with the kids over whom he towered, and the attentiveness of everyone on our team to everyone else, past the patients to everyone in the hospital regardless of role or involvement. I was more than awed by the expertise of the nurses, their quickness and ease of movement. Sometimes I want to be them, with so much concrete need in their hands, more presence to their kids.

*Memorizing contours from senses: We've absorbed so much from sight and experience, almost without effort, that I wonder why I've tried so hard all my life to pound all that's outside inside. I think I felt this most with my last patient, who sometimes slept with his glasses on, and whose facial features would register at odd moments. Long after the day was over I found myself worrying about how he'd grow up and whether he'd gain the comfort of a secure home, the self-confidence of good health taken for granted, and the weight to develop into a person that could physically stand among others. He smiled inadvertently and in surprise when I beat him in Connect Four, with a diagonal line he hadn't noticed. When I remember that, I worry also that his teeth might always be in the wrong place.

*Seeing people return: I've seen more than a handful of patients return: with the same thing, with the same thing but worse, with a different thing, for nothing at all. It is strange to feel some sense of accomplishment with sending a patient home, then to feel a sort of regression when they return, because it's the same person. There's a disconnect between the linear or even cyclical image we have of a person's life, and thereby our relation to it, and the connect-the-dots relationship we actually have with them. I was disconcerted by some of the discontinuity, some of the chronic non-health problems.

*Seeing people disappear: We talked about how we thought she would still be there when we finished our month of inpatient pediatrics. Each day hearing of her tiny progress, only to find out the next that she'd deceived. She wasn't healed when she left. Watching her leave that one day, one day earlier than had been scheduled earlier that week, many days earlier than in my mind--face and nails made-up and leaving me a sense of glittery blue even as I'm unsure that's what she was really wearing--I felt I understood so little.



A., who likes to sit next to waterfalls, talks often of being humbled by feeling his smallness among big things and his incapacity to know anything in this vastness, and recently listed a slew of good places to perceive this: in the hospital, in a warzone, in love. I hope that the next time I forget, I'll try to think on how the immensity of small things and small people made me feel small too.