Confessions of an Intern

Week Ten

This sucks. I'm tired, I'm frazzled. I feel so much like a fish out of water that I constantly feel off kilter. I wonder if it's because I really don't know what is going on, or because pediatricians act like children are a different species. Children are human beings, they just have a little bit different way of responding to some medication. That is not a mystery. It is a fairly basic concept. I can get that. I'm tired of feeling like they are waiting for me to screw up. I've been told by two attendings that I'm doing really well for being a family medicine intern. What is that supposed to mean? Is it just because I'm not a product of the pediatric institution it's suprising I do well, therefore an enigma; or the fact that I am successful as a transplant for the month from an outside residency program, or is it simply a bias against family med? I would like to give them the benefit of the doubt. Oh well...just a rant to vent. I am feeling overwhelmed, a very unusual feeling for me, thank God. But it is good for me. It is a challenge for me to work harder and learn more, eventually.

Anyway, on to the real reason I'm writing. The kids...the babies...the living dolls. Yes, you read correctly. living dolls. Between the run of the mill bronchilitis, asthma, gastroenteritis, reflux and infections, there are a large number of kids that are alive, but essentially vegetative. They are the way they are for various and sundry reasons, all with the same devastating results. Anoxic brain injury in the infant leads to global developmental delay, global encephalopathy, cerebral palsy, etc, etc. The maybe unfortunate result for many of these kids is that they are in fact alive. Their heart beats, they breathe, they open their eyes and look around and some cry. They pee and poop. But there is really no recognition, or if there is, it is happenstance.

This has led me to think about my current belief on life. What is life? What does it mean to live? I had this conversation with a medical student and realized there is not a good definition of alive. Does the fact that there is a beating heart and spontaneous respirations mean one is alive? What would life mean to you if you suddenly could not recognize any of your loved ones, could do nothing for yourself, could not communicate, were completely dependent on others for absolutely everything you did? Would it qualify as life without the ability to have interpersonal interaction with anyone? What if you never were able to know your loved ones, if existence was merely all that you were able to have? No true meaningful interaction with anyone.

Many of these children have suffered devastating injuries, and it could happen to anyone. Accidental smothering while co-sleeping with a baby, a micro-preemie with every complication that can happen except death, or what is euphamistically called 'NAT' in the record--non accidental trauma. Wrap your neurons around that and it means child abuse. They did not ask to be the way they are. I am having a difficult time putting into words what I feel, because it is not a topic that many want to think about. Basically my heart is breaking. I feel it is cruel what some of these children must endure just to 'live'. Repetitive surgeries, infections, suctioning, poking, prodding, resuscutation...then just laying there, in low stimulation environments so they don't have a seizure. People wouldn't do this to animals.

Now don't gasp in shock and horror. I have thought long and hard about what I would do if one of my children suffered a head injury and became like these kids. I cannot even honestly tell you, because the thought of losing one of my sons is horrifying...however, I would hope that I would be able to make an educated decision, not unlike end of life decisions with our elderly loved ones. I mean, thinking of quality of life, humane treatment, and how long and to what extent do we sustain a beating heart? Just because something can be done does it mean it should?