Reflections on Pediatric Surgery

Ok, so sometimes I ramble. I can't think of a good forum for it right now, and I'm kind of in a wierd mood right now, and I feel like getting some thoughts off my chest.

I don't get much time to think while I'm at the hospital. I'm usually so busy that I just get to react. "The patient's lungs are crackling. That's bad because it could mean a pneumonia. I need to call the resident. I need to get a chest X-ray. I need to write it in the patient's chart." That sort of thing goes on all day.

When I come home, the last thing I want to do is think about work, so I'll go to the pool and swim, or play a mindless video game. Or spin poi if the weather is cooperative.

But sometimes, I get to thinking and I need to organize my thoughts. So here goes.

In the old days, when kids got sick, they often died. A kid born with what is now an easily corrected problem (a cleft lip, a hernia, a bowel obstruction, etc) had no chance back then. How many of us would not be here today if not for modern medicine? I sure wouldn't be.

But I've dealt with some sick kids and some really sick kids. The sick ones are easier. Most of them were healthy and got sick. We can fix that. But the really sick kids were born sick. And it's sad to see some of them. Bed-ridden, unable to interact with others, trapped in a life of grunts, diapers, and painful contractions and seizures.

And I see it starting every day. With recent advances in the care of infants, we're keeping more kids alive today who would have died than ever before. But the ones we're keeping alive now wind up severely disabled.

And I wonder. Isn't that cruel? Shouldn't we just keep the baby comortable and let nature do its thing when we don't think the long-term outcome will be good? Why do we fight so hard?

I've almost forgotten what a healthy baby looks like at this point. When I think "baby" I think of a small, skinny kid in an ICU bed wired up like an underground system. I saw a real, healthy baby today in the hospital. His mom worked there. He was beautiful. I didn't have to examine him constantly and write down his vitals. He smiled and drooled at me. I didn't have to worry about his urine output and sodium levels. He was awake, alert, and made eye-contact with me.

So why do I love pediatrics so much? Shouldn't I hate it since I hate seeing sick kids? Why do I jump out of bed every morning excited to see the kids? Why am I excited to see death and destruction like I do?

And yet it tugs at my heartstrings. Yesterday, a pretty sick 5-year-old girl looked up at me and wimpered "I can't breathe. I'm scared I'm gonna die." And my heart just melted to a puddle of goo. All I could say was "Oh ho, honey, we won't let you die!" I felt so horrible that she felt that way. It must be awful to be 5 and terrified you're going to die. It must have been more awful before there were doctors.

But did I make her better? Did we? We can't figure out why she keeps taking oxygen to keep her oxygen saturations up. We can't figure out what's wrong with her other than the fact that the numbers are wrong and yet she's feeling great today.

I love working with the otherwise healthy ones. They're easy. They're happy. They make me happy. I've done something to help someone. But with the really sick ones, I wonder what the hell I'm doing and if I'm really helping anyone. It's so frustrating because I feel like it's a moral defect that I can't automatically see the value of every human life.

But I love it. And on some deep level, I believe in what I'm doing.

[ 02. November 2003, 11:57: Message edited by: Lïghtnïng ]

that ramble is perfectly acceptable, because there is no right answer - writing things down does get your thoughts in order, but its still a tough debate - that really has come into the limelight with the medical advances over the past 100 years.
there are some kids in serious pain because they have survived, and some kids who go on to leading rich and fulfilling lives because they survived - many of which probably wont remember the wonderful people who tried so hard to give them a chance.
all you can really do is to try your best - both with your mind and heart.

The human race isnt survival of the fittest and I have often wondered if that contributes to a less stable genepool and so more cancer and autimmumebased disease etc. Large numbers of western babies arent dying just after birth or in the first year. 80 odd years ago most mothers had insurance policies to cover the cost of burying their babies and in a quick look at old cemetaries you see many graves of babies.

Its heartbreaking to see those kids trapped in a life with minimal communication and nappies then grow up into adults but in our society they are no longer left to die early. Its frustrating to see these innocents given less rights than murderers and rapists.

My husband is a severe asthmatic and I was a rhesus baby and so we would have died in our first year of life, our eldest boy has type one diabetes so we are a pretty bad bet gene wise.

We are blessed to live in a country with an adequate health system that we no longer have high infant mortality rates

Lightning I find your posts are often thought provoking and insightful. Keep it up.

I don't know if I will ever have children, not because something is wrong, but because I just don't know what life has in store for me, and I don't have this planned out.

But if I do have children, and one or more of them is seriously unwell, I do not know how I will cope. I know I have tendencies towards depression. Would I be able to cope, or would I do them more damage?

I can't answer this, and I can't answer your questions Lightning.

Just thankyou for being a person standing there saying wonderful words to someone who really needed to hear it. I know I would want the same for my children.

Lightning,
I was involved in a horrendous car crash 11 years ago which resulted in my 11 month old daughter suffering brain swelling from impact and coma.If she survived she wouldn't have been the little girl i knew..she didn't survive but if i had had to decide for her,i think i would have let her go rather than put her through suffering.
So you see,even parents feel the way you do...ultimately you just want to ease suffering,which is a GOOD thing....

Woodnymph thats an experience no parent should have to go through. Such a stressful time I dont envy you. Take care

this is kinda the sharp end to the euthenasia debate innit...

my sympathies mr mike sounds like you're going through thoughts that noone would want to have, and in a field were there's no chance everything will work out alright. seems to me it would be too easy to forget all the healthy babies as they're around for so much less time.

hope you can keep seeing the positive

If it wasn't for modern surgical procedures either my mother or I would have died at birth after tying my umbilical in a big knot around me.

My cousin was way premature at about 22 weeks. She was in a ventilator for 15 weeks, has had to have open heart surgery, corrective eye surgery, numerous bouts on her limbs, has bad cerebal palsy and is in a wheelchair most of the time. For her quality of life should they have fought so hard? She thinks so.

It's the innocence of the kids.. so pure and untaited that makes the difference me thinks.

One thing I find is that I find it easier to feel sympathy for the kids. On adult surgery, my patients were often obese diabetic smokers with poorly controlled hypertension.

My feeling towards them was "Look, you're here because you didn't take care of yourself. This is your mess and now you are making work for me because I have to fix it. If you'd just taken care of yourself, you wouldn't be in the hospital right now."

But with the kids, it's not their fault. Even if it's trauma with some kid doing a bonehead stunt, I can forgove that. Kids are SUPPOSED to do bonehead things like that. And the others didn't do anything to get sick, they just got unlucky.

I find that motivates me to go the extra mile.

Wow Doc Lightning! That's a hard one. There doesn't seem to be any answer. But I just want you to know that I'm so grateful that you're there for all of those kids! Whether they're really sick or only mildly sick. It's nice to know that there are people like you out there to help them! I hope that if my kids were to ever need San Francisco Pediatric Surgery that there'd be someone like you for them.

Uber bump, what were you searching for?!

Wow. Eight years ago. Eight years ago I was a medical student on my pediatric surgery rotation.

Today, I'm an attending pediatrician in an outpatient setting. I've been through a pediatric residency and I've seen things I never thought I'd see. And I've grown immensely. I don't think I'd recognize myself back then.

And yet... that post I wrote eight years back is spot-on.

i started reading without date checking and was wondering why you needed to get the resident
(i was thinking, surely Doc doesnt consider some jobs 'beneath' him now)


its not just children that we save to end up with troubled lives. extending the lifespan of people isnt akin to extending the quality of life, but thats a whole other discussion.

BTW, I still remember the sick 5yo girl from those eight years ago. She'd be about 13 now.

She wound up being septic. She went into cardiac arrest and died... but we had an ECMO (basically heart/lung bypass) circuit ready for her. We literally kept her dead body perfused and oxygenated even though her heart had stopped.

And then it started beating again. And she woke up. She left the hospital a few weeks later as a healthy, normal child. We brought that child back from death. To this day that case shocks and awes me.

That is the power of science and medicine. As I use these amazing powers in my day-to-day career, it never ceases to amaze me what we've learned to do.

win!