November has started, and with it, my month of Pediatric ER at one of the other community hospitals. It is one of the larger hospitals in the system, and one of the only hospitals with a pediatric ER. I was very nervous when I started, because I thought I wouldn't know anything, and be in the staff's way the entire time, but to my surprise, I have learned something in the last year and a half, and I find myself with at least half a clue about the assessment and plan of most patients. Sometimes, it is only one-fourth of a clue. Sometimes, especially on musculoskeletal issues, I know more than the attendings do.
Every shift seems to have a theme, and today's was psych day. Every child seemed to come in with some sort of psychiatric complaint. Each of the attendings and PAs had at least one psych case to deal with, and now it was my turn. The patient was in his late teens and had been brought to the ED by his frantic mother because his high school counselor stated that he had suicidal ideations. When I saw the patient initially, he refused to talk. Every question was a one-word answer. Finally, I politely asked his mother to step out of the room, and suddenly, the words started pouring out. His parents wanted him to pursue a field he hated, but they would be the ones paying his tuition. He didn't want to disappoint them, but he couldn't imagine a life stuck in middle management in a white collar job.
His peers at school hated him for being weird. His teachers didn't like him because he didn't pay attention. High school was "a prison" to which he was forced to endure on a daily basis 5 days out of the week. He wanted something more, something different, but there seemed to be no way out.
I saw this patient, and in him, I saw 15-year-old me. I didn't fit in and I had few friends.My low self-esteem was reinforced by the fact that I was almost never invited to outings or gatherings. I thought that my parents hated me and I hated them. I wanted to escape from parents' goals and aspirations, and I wanted to be a success without their input. High school was one of the most dreaded times of my life. And yet, ten years later, here I was. Face to face with the ghost of Christmas Past.
Today, I was able to tell this boy-man that he will be okay. That this agony will pass, and one day, he will be happy. That high school sucks, but it is better on the other side. I looked him in the eyes, as I wished some adult would have done with me, and told him that he was worthy and that he would eventually be able to become the person he wants to be. It won't be easy, but with enough hard work and determination, he will eventually escape from the darkness and depression and find his way to the light. Find people who will like him for who he is, and be amazed at the talents he brings.
This patient was one of too many to count today that I saw during this shift, but it may be the one that matters most. The long nights of work and study, the anxiety of exams and practicals were all towards this goal. To reach people who really need it, and offer an hand towards recovery.
This is why I am a doctor.
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