Julian Diaz Abele
Class of 2015
What does it mean to be a healer?
The notion of healing versus curing is alluded to over and over throughout medical school to the point where the word healing loses its deep meaning and becomes white noise in the never-ending, dynamic life of the hospital. Yet, in the day-to-day life of observing, listening, touching, and talking to patients, I have found a deep, amorphous, and soundless feeling that might come to resemble the windy word healer. It is when the noises of the ward or operating room fade, and when all the worries that I carry slip away, that I feel this unique and strong connection to the patient in front of me. In that moment, I understand.
When I started my rotation in pediatrics, I was somewhat terrified. I had the impression that newborns were more delicate than porcelain, and as little as a touch in the wrong corner could shatter them to pieces. However, they are as resilient as bubblegum. One of my first patients on the pediatric ward was baby SR. He was only a few days old and presented with persistent vomiting after every feed. I suddenly found myself responsible for a tiny baby who was unable to feed by mouth and whose mother had been hospitalized for postpartum complications. I was terrified. I consolidated all the knowledge I had, came up with a differential diagnosis, and went into the room to meet my patient.
I worked hard to represent the pediatrics team. The pediatric specialists, nutritionists, geneticists and gastrointestinal specialists worked endlessly to attempt to understand the illness of baby SR. Every day, I would visit baby SR, observe him, listen to him, examine him, and talk to him. I don’t know for whom I spoke, but these moments were as soothing for baby SR as they were for me. I must have seen him more than I saw my family and friends combined. At the end of every day, as I walked home, I would review all the possibilities that could ail baby SR. Despite my inconclusive hypotheses, I knew something was certain – SR needed his mother. As I arrived at the hospital on the Sunday morning of that first week, I was elated at finding a woman holding him. Baby SR's mother had been discharged from the hospital and could now be part of the team.
The first two weeks of care consisted of eliminating all possible causes. We imaged SR's neck, chest, and abdomen, we watched him swallow frame-by-frame, and looked into his gut with a camera through his mouth. No matter what we did, we could not truly understand what he had. After two weeks, we gave up on our attempts to feed by mouth and started to feed him with a tube that went into his stomach by first passing through one of his nostrils. This form of feeding is non-invasive and commonly used in the hospital. Yet, for the mother, this was worse than any scoping or surgeries that her baby could have had. I spent time explaining to the mother what the procedure was, but only after I understood her real concerns did I walk her through the ward so that she could meet all the smiling babies that were similarly fed. After this experience, she readily consented. What may be common for a physician might be a life-changing event for a family. We must never forget to see through others’ eyes.
Despite having no medical treatment to cure baby SR, I would visit him every day and listen to his healthy heart. I would examine him from head to toe, although I knew that neither my stethoscope nor my hands would diagnose his condition. Perhaps I persisted because I felt that my physical exam was therapeutic rather than diagnostic. The exam was a way of communicating with baby SR and his mother, letting them know that I was with them and that they had not been forgotten. I did nothing more than feed baby SR drop by drop though his tube and act as someone to lean on.
The plan simply consisted of increasing the rate of drops baby SR received so he could safely go home with full liquid meals. After 4 weeks of care, although baby SR was closer to taking full meals, he was still not ready to go home. It was the last day of my rotation on the pediatric ward. I had been able to discharge all my patients except for baby SR. I couldn’t build the courage to inform the family that I would no longer be able to follow baby SR as part of the pediatric team. It was a busy day and I was only able to join them late at night during my last day of rotation. I sat with the parents and explained to them how medical students go though different services every few weeks and how I would move from the pediatric team to the neonatal intensive care team. I could see they were just as sad as I was to say good-bye. To thank me, they gave me the names of all their family members and explained the meaning of their baby’s name – “the light of dawn." They wished goodbye with kindness: “may god bless you with peace.”
I was somewhat confused. I was upset, for I felt I had failed baby SR and his parents. I had been unable to cure him, yet never had I received such a beautiful gift as the one I received that day. I couldn’t understand why they would be so thankful. Their baby was still in the hospital and could only be fed through a tube. It was some time after, while writing this story, that I realized that they thanked me not for curing, but for healing.
Without realizing, I had been more than drops for the baby and a shoulder for the mother.
Coda: Two weeks after I left, baby SR had progressed to full meals and was discharged home, yet no one knows with certainty what he had.