“My ‘medicine’ was the thing that gained me entrance
to these secret gardens of the self. It lay there, another world, in the self.
I was permitted by my medical badge to follow the poor, defeated body into
those gulfs and grottos.” – William Carlos Williams
“Faithfulness in the day of small things will insensibly widen
your powers, correct your faculties, and, in moments of despondency, comfort
may be derived from a knowledge that some of the best work of the profession
has come from men whose clinical work was limited but well-tilled. The
important thing is to make the lesson of each case tell on your
education.” – William Osler
It is around this time of year when fourth-year medical students
contemplate the implications of their residency choice and third-year students
and residents hope for clarity in their career thoughts. Those of us in
practice are often asked two important personal questions: 1) why pediatrics
and 2) why general pediatric practice?
William T. Gerson
While I am certain our colleagues in other fields are asked
correspondingly similar questions, to me the perspective is different. I might
be wrong, but I believe that there has always existed an uncharted tide of
puzzlement in the choice of pediatrics, and an even higher, more treacherous
one in terms of general practice. It is as if by this choice one gives up some
large share of “medicine,” as taught in the previous years of
Exciting area of medicine
I wear my bias on my sleeve. When I made my decisions, I believed that
the field of pediatrics truly was the most exciting area of medicine. And I
still do. Where better than pediatrics to observe (or discover) the
translational impact of the unraveling of the human genome; clinical
ramifications of alterations in the biochemical pathways we so recently learned
in such detail; vast panoplies of human growth and development; excitement in
the intensive care of newborns and children and the disproportionate influence
success would have on quality-of-life years; vibrant intersection of public
health on individual health; and most importantly, the chance to become an
important part of people’s lives by assisting them in one of life’s
most basic needs — the care and nurturing of their children and families.
I fervently hope those asking the questions have the curiosity and passion that
our field deserves. However, what I point out most ardently is the counter
question — With whom else would you rather spend your career than with
individuals who have chosen pediatrics as their life?
Feeding the soul
Some days it might be hard to remember — let alone validate —
the correctness of our own decisions. For how long do the rewards of our
practice last? As is truly reflective of primary care, where we provide
longitudinal care, what we reap is also longitudinal, and happily also
reinforceable and cumulative. As a third-year medical student on a pediatric
oncology elective, I participated in the care of an infant newly diagnosed with
a Wilms’ tumor. Her initial care was successful and uncomplicated. To me
it was an introduction to comprehensive patient care, cancer biology and the
importance of clinical trials.
In the traditional student role, my interactions with the family lasted
less than 2 weeks and then I was on to other rotations. At my graduation 18
months later, I received a note from the family thanking me for my care and
wishing me the best in my future as a physician. That memory returns to me in
practice — not often, but enough to feed my soul.
The small interactions that we have over the course of a day in practice
that replenish our “medicine” I suspect sustains us all. I’ll
briefly describe those special encounters that I remember from last week’s
office schedule and ask for you to remember yours.
- The 18-year-old who returned for a physical after not being seen for
4 years because of an insurance coverage ruling mandating a provider change (I,
of course, was unaware). Healthy, ready for the transition to college, he had
made many good life decisions. I met with his mother after the visit to touch
base with her and to exchange thoughts about her son and his four other
siblings. While gratified that they chose to return, I also realized that I
felt a deep sense of loss that I had been unable to share in the past 4 years
of their collective lives.
- The 27-year-old woman, a former patient, who chose to bring her
newborn son to see me.
- The mother of a 16-year-old young women, a patient of one of my
partners who came in for a sick visit because of a persistent cough, who
mentions to the daughter that I was the first person, other than her parents,
to see her in the hospital after her birth. (Thanks to the paper records of the
time, a copy of which we could bring back from the hospital for our charts, I
could quickly verify the event. Try that with an EMR!).
- The 14-year-old who shares his questions over his sexual identity
with me as the first person he felt he could talk to and who seeks help in
discussing his concerns with his family.
- The 16-year-old in her hospital bed who just needed a hug before her
first dose of chemotherapy for acute leukemia.
Just another week in the office.
To those with the right questions — pediatrics is always the
William T. Gerson, MD, is Clinical Professor of Pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. Disclosure: Dr. Gerson reports no relevant financial disclosures.