On stillness

When I was a resident, in one of the largest medical centers in the world, any day I was on inpatient consult service would be a day I exceeded my step goal. Without fail. I'd arrive to the fellows' office early in the morning, spend the next 10–12 h traipsing around multiple different buildings—the children's hospital, the women's hospital, the adult hospital, the other women's hospital, the medical school—before exhaustedly making my way back to the fellows' office to pack up my things, head home to get some precious sleep, then wake up before the sun to do it all over again. Constantly moving, constantly on the go. On consult service as a trainee, my internal pistons fired ceaselessly. Now, as an attending at a different health system, the geographic surface area I cover walking to see consults may be less, but the low-level buzzing in my chest whenever I'm on call persists, and the routine remains the same. I get paged, review the chart, go see the patient, call the team, order testing, write the note, rinse, and repeat.

Not long ago, during one of my call weeks, my phone pinged with the unique alert I assigned to our hospital system's internal paging app. A new consult, this time from the pediatric intensive care unit, from which many of our consults originate. I scanned the information provided as my brain began whirring, trying to read, process, and act all at the same time. Baby. Very sick baby. Unclear reason for decompensation. Parents at bedside. Probably needs broad testing with parental samples. As I looked through the chart, gathering background information, I was simultaneously pulling paperwork and educational materials from my desk drawers in preparation for my discussion with the family.

At my next break between clinic patients, I briskly walked from my office in the outpatient clinic building, across the big blue skybridge often used as a can't-miss-it landmark on the medical campus, into the main children's hospital. I hopped in the elevator and pressed the button for the ICU, still mentally running through my growing checklist of tasks.

When I arrived in front of the correct room, double checking the notes I had scrawled onto a sticky note to confirm, I noticed that this patient had been already been admitted long enough for the nursing staff and child life specialists to have helped his family create a colorful decorative nametag for his door and tape photographs of his cheery face from better times in the skinny window. I took half of a second to look at each photo. It helped ground me in the context of the conversation I was about to have with a worried, hurting, possibly traumatized family. A conversation that I'd had many times before and would have many times to come. Even if you're not the sickest person in the hospital, no one is getting a genetics consult on the best day of their life. A customary knock, then I stepped into the room.

The baby appeared far too small to be laying in a standard-sized hospital bed. Pale. Intubated. Not sedated, but very still. So still. I came to the sobering realization that this baby wasn't just sick, wasn't just dying—it seemed like he was already gone. His body was there, but whatever mysterious energy made him the smiling boy in the photos outside his room had left us all behind. Thoughts of my infant daughter came unbidden to my mind. My daughter, who, at my 20-week anatomy scan, was the “most active baby” the sonographer had seen in some time. My daughter, whose arms and legs are constantly moving, even while she's sleeping. My daughter, who can never be found in the same spot you left her, even though she can't yet walk. My baby, who is never still.

I help take care of sick babies and their families all day long. Confronting illness and mortality is a routine occupational hazard. But something about that baby struck me directly in my heart and in that moment, I shattered. I cleared the distance between the doorway and the hospital bed in just a few strides and scooped that little baby up, holding him against my chest. I swayed slowly on the spot, as if I were trying to soothe him back to sleep. I whispered that he was safe, and that he was so very loved.

But of course, I didn't actually do any of that. Because I'm a physician and I need to act like one. Instead, the opening script of my mental teleprompter began to scroll. I introduced myself to the family. I asked about their understanding of why the genetics consult was requested. I confirmed a few details of the baby's history, drew out a comprehensive, three-generation pedigree based on the parents' best memory of aunts, uncles, and grandparents, and explained that I would be examining their baby before looping back to discuss my recommendations for testing.

Walking over to the side of the too-big hospital bed, I reached out and stroked the wispy hairs on top of that baby's head, under the legitimate task of checking for skull shape and fontanelle size, but also attempting to impart some warmth and tenderness at the same time. I assessed his facial features, gently turning his head to visualize both ears. I picked up his small hand to examine his palmar creases, his fingers, his fingernails. I gently pressed on his abdomen. Throughout all of this, he never stirred. He never pulled away from me, never reached out to his parents for comfort.

Once I had examined him from head to toe, I took a final step away from the bed and turned back toward the family. Automatically, the internal checklist fired up once more. Discuss findings. Review testing options. Shared decision-making. Obtain informed consent. I wrapped up with the family and excused myself from the room. Need to place orders, need to complete paperwork, need to write note. I tucked away the flood of emotions that had rushed through me just moments before, needing to save it for later, when I wasn't so busy. I folded it up and put it away in a storage box somewhere between my chest and my head. Hidden until I had the time to stop and process, if ever. After all, being on service at a tertiary care center, there's always something that needs to be done.

It wasn't until weeks later, after several nights of lost sleep and several days of increasing anxiety, that I realized how deceptively permeable that storage box really was. I was in the middle of troubleshooting my recent irritability and feelings of tension with my ever-patient therapist when the memory of that consult unexpectedly jumped to the forefront of my mind. In my surprise, I think I actually paused and voiced, “Oh.” And in recounting the story to another person, in saying the words out loud, the box finally burst open. I cried the tears that I had unknowingly been saving for that sweet baby, who had indeed passed away during that hospitalization. I put away my checklists and reminders and took a moment to just be sad. To recognize the impact of the experience had on me. To acknowledge that by doing so, by allowing myself to feel, I was working on source control instead of just symptom management. I was taking some steps to heal.

As physicians, we are professionals, it's true. The process of medical training selects for resiliency and endurance, which are certainly helpful traits to have, particularly in subspecialities like mine, where the rare, the unknown, and the presence of many remaining questions are the daily norm. But physicians are also, and at foremost, people. People seek connection with others. People are vulnerable and can get hurt. People need to grieve.

I still don't understand why it was this baby, out of all the babies I see at work every day, every week on call, that sent me to a forced system reboot. I'm not sure we can ever predict who those patients will be. But what I do know is that I am grateful for having met him and his family, despite the tragic surrounding circumstances. They reminded me of the normalcy of feeling, reminded me to pause and hold space for my emotions. That I am still a person, even if my process to ensure maximum efficiency on call might seem somewhat machine-like. They reminded me of the importance of being still.