Monday, November 27, 2006

Peds Night

Anyone who's spent time in an ED knows that cases come in waves. There will be five head lacs at the same time, or three strokes, or four migraines. One corner of the ED will be populated entirely with young women who've attempted suicide, or elderly patients who've broken their hips, or teenagers who've had bicycling accidents.

Last night was peds night. We usually get a let of kids with coughs or runny noses whose anxious parents have brought them in to be checked out, but this was different. I counted at least four very sick and unhappy kids, ranging in age from infancy to early school age. At least one was admitted. One had a viral illness unusual in a child that young (I overheard one of the docs saying, "I can't believe I tested a toddler for that and it came back positive"). One child, who already had complicated health issues, came in after a frightening episode of what will be another chronic condition. The least sick of these kids -- and the one I know went home -- had to undergo a painful procedure.

I wasn't in great form last night anyhow, because I was extremely tired despite a long afternoon nap. (I think my father's saga was catching up with me.) On nights like that, I always tell myself that a half-baked chaplain is better than none, and I know some patients were glad I was there.

But dealing with sick kids is a special challenge for several reasons. I don't have kids myself, so I'm less adept with these cases than I would be at talking to patients facing conditions with which I've had first-hand experience (cancer, stroke, depression). And the suffering of children is a pastoral and theological nightmare, automatically raising thorny questions about how a loving God can allow that kind of pain.

There's no way to blame kids for their own suffering, as we're often so eager to do with adults. ("If you'd only taken your meds/stopped drinking/worn a seatbelt, this wouldn't be happening!") It's very hard to label children "guilty," and most of us -- thank God -- would recoil from even trying. Parents feel especially helpless when their children are either too young or too ill to talk, as was the case with most of the peds patients last night. When the parents identify strongly as Christian and ask me for prayer, I'll often insert a phrase about how the God we worship weeps with them, because he endured the agony of watching his own child suffer. Parents seem to find this reminder comforting, although in more academic settings, it raises thorny theodicy issues of its own.

Last night, only one of the four families -- the one whose child had been admitted -- requested prayer. I didn't think to insert the phrase, and I'm not sure what difference it would have made. They were all exhausted; at that point, the kid was doing better than the adults were.

Of the other three families, one politely sent me away. The other two didn't ask for prayer. They needed to talk about how hard it was to feel so helpless. I said, "This is probably harder on you than on your child," and they agreed.

Everyone on the staff was exquisitely kind to these families, of course. Sick children bring out the best in adults. Nurses go out of their way to provide extra care; harried doctors slow down for a minute to admire the baby, or talk about their own kids.

And these cases move other patients and their families, too. The child with the chronic health problems was in a bed next to an adult patient and spouse. When I visited this second family, the spouse was crying. "I heard what those people next door are going through, and I can't imagine it. That sure puts things in perspective, doesn't it?"

Yes, it does. (Oh, and by the way, do the HIPAA police really think those flimsy cotton curtains between beds do anything to protect patient privacy?)

As much as I hate seeing children in pain, I find myself wishing that every ED patient received this kind of compassion. Anglican activist Louie Crew tells the story of asking Ernest Gordon, who was a prisoner at the River Kwai in World War II, how he survived being tortured:
"I practiced the discipline of remaking the face of each torturer into the face his mother had seen cuddling him in her arms," he said. "It is very difficult to be swallowed in bitterness when you can do that, and it is the bitterness that would have killed me, even had I lived."
When I'm talking to a very difficult patient, someone I'm tempted to blame for her or his own suffering -- "If you'd only taken your meds/stopped drinking/worn a seatbelt, this wouldn't be happening!" -- I sometimes remember to practice that same discipline, to try to see the patient as a beloved, suffering child. I'd like to think that this is how God sees all of us, even or especially when we're at our worst, and I have a hunch that the discipline benefits me even more than it benefits the patients.


  1. My eldest, Matthew, was 18 months old I suddenly had the urge to get home - we didn't even have a telephone in those days. We spent that night holding his tiny hand through the bars of his hospital cot while the fever broke - stick thin in just a nappy and clutching a yellow tennis ball in his other hand. He was okay in the end (he's 6ft 4ins of very boisterous young man now) - nothing that grommets in the ear didn't put right - but I swear he was giving me his strength that night.

    Then Lucy was stillborn not too long afterwards, and I ended up comforting the doctors and nurses and midwives (all of whom were Cathie's colleagues, so really were blaming themselves) I even comforted Graham - our minister - because he was in tears and speechless, and I wasn't (not just then, anyway).

    They were two 'footprints in the sand' moments, and I know we were not alone.

    As for the question, I know in my heart what the answer is for me, but we each have to find it for ourselves and I have prayed daily for more than twenty years for all parents who find themselves in that position. You being there, God's love on legs, is far more important than I think you know. It ain't such a rickety contrivance, and bless you for being there when the going was as tough as it gets.

  2. Martyn,

    Thanks so much for this very moving comment. I'm so sorry that you never got to know Lucy.

    And I'm very glad that Matthew was okay!

  3. Shauna10:45 AM

    Lovely post, Susan. And Martyn, "God's love on legs" is a wonderful phrase I know I will use in the future.


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