The Parent Trap

Parents: one of the most oft-cited reasons by physicians in other specialties that they chose to keep their distance from pediatrics.  And one of the factors that convinced me that the field was right for me.  In the personal statement for my residency application, I waxed poetic about how much I enjoyed the task of explaining things on two levels – to the parent as well as the child – even when differences in understanding, values, and culture posed additional challenges.  To me, parents were just another appealing aspect of the field.

So of course I had my first made-me-want-to-scream parental encounter early in my intern year.

It wasn’t that the parents were overly rude.  And it wasn’t that their child’s case wasn’t serious.  It was that they first wanted the medical team to alter our treatment plan because the very well-established standard of care for this particular illness simply did not mesh conveniently with their lifestyle.  Then, once I had discussed at length with them the disease and rationale for this treatment and they had decided to go ahead with it, they needed every detail put into place rightthisverysecond.  Why, they wanted to know, was I still standing there talking to them?

When I finally had a spare moment in the resident workroom, I paced in agitation as I vented my frustration to the senior resident who oversaw our team.  How could people be so entitled?  How could they try to deny their child the only proven treatment for a serious condition, and then, once on board, demand immediate service as if they were the only family in the hospital? My senior listened patiently, his grin a mixture of amusement at my impassioned recount and a caution that I should get used to this. The chief resident, who had peeked her head in the room to check on the day’s progress, ducked out then returned with a can of green Play-Doh.  “For stress relief,” she said as she slid it across the table in my direction.

A few phone calls and electronic order entries later, I trudged back up to the patient’s room armed with the news that the treatment would commence far earlier than anticipated and their discharge home would thus be expedited.  I found the patient sleeping while the mother barked into a cell phone.

She spoke tersely, enunciating each syllable.  She looked up at me and rolled her eyes as if we two represented an alliance against all that was stupid in the world.  “No, I said three round-trip tickets.”

And an alliance was exactly what I wanted.  I found myself speaking with ingratiating sweetness, my tone all chirpy and won’t you please like me and can’t we please just get along?

I explained the next steps in the child’s care.  She listened, then began to apologize . . . that she needed to leave. It was just that this new development, this incredibly inconvenient illness and our stubborn resolve to treat it in this way were forcing some alterations in the family vacation and, well, I just knew how imbecilic those travel agents could be, didn’t I?  She was just going to have to go take care of the adjustments in person.  She would be back later that evening; maybe at that point we could start discussing discharge plans?

I listened in amazement to my own voice making one more high-pitched stab at pleasantry, remarking how lovely the trip sounded, how it would give her child something to look forward to and allow them all to put this illness behind them.

You want so badly for her to like you!  I realized as she nodded absently and I made my way to check on my other patients.  But why?  She had agreed to the best treatment for her child; wasn’t that enough?  Did we need to be buddy-buddy, too?  Would winning her approval of our plan, of our medicine, of me, somehow erase her maddeningly entitled ways and make everything alright?

Parents: one of the unique aspects of pediatrics.  Bane or boon, depending on whom you ask.  I had encountered dozens already, some of whom I had bantered with in a chummy rapport, some of whom had concerned me with their lack of attention to their child’s needs, but all of whom I had treated with professional respect and politeness, and whom I felt had largely accorded me the same.  None had infuriated me in this way.  None had tried my patience and thrown me so off-kilter, challenging my ability to keep my emotions restrained.

Yet, too, none had led me to such introspection, such an examination of my visceral responses.  As I peeled flecks of green Play-Doh from beneath my fingernails, I had to admit that none had left such a lasting impression that, despite its frustrations, would arm me for future such challenges.

And there will be many, many future parental challenges.  After all, it’s pediatrics.

Language Lessons

I meant to learn Spanish a long time ago.  The years between college and medical school seemed like a clear opening, although I found plenty of ways to busy myself.  At one point I signed up for a Spanish Word of the Day email service, and dutifully copied and pasted each day’s nugget of knowledge into a comprehensive spreadsheet.  It turns out, though, that you don’t actually learn anything if you never revisit said spreadsheet.

In the first semester of medical school, I jumped to sign up for an evening course in medical Spanish.  It was a hodgepodge of students with abilities ranging from no foreign language knowledge to a substantial recollection of college Spanish, as well as one who spoke fluent Italian.  After a few sessions spent gamely following along as the instructor attempted to wrangle us through a variety of exercises that suited no one’s ability and guiltily promising myself that the following week I would devote some time to my medical Spanish workbook rather than losing it under the mountains of anatomy atlases littered around my apartment, I politely withdrew.

When I began residency, my husband and I moved into an apartment halfway between the cities where we worked.  My husband traveled by train, while I drove twenty miles down the highway to my hospital. A coworker told me of a friend in a similar situation who had used CDs to master Italian during his commute.  Armed with new determination, I secured a library card and borrowed a 3-CD set of instruction in conversational Spanish.

On the drive to work the next day, I learned several greetings and introductions.  When repeating the examples offered by my faceless instructor, I proclaimed them with gusto.  I rushed ahead during translation exercises, the overzealous student shouting out the answers before the teacher calls on her.  The warm voice coming through the speakers told me I was doing muy bien.

That afternoon I attended my first session of residents’ clinic.  I was scheduled to only see a few patients while I learned to navigate the flow of the clinic and familiarized myself with its electronic medical record system.  After yet another day of feeling lost of and overwhelmed, I began to relax as I finished writing my notes.  I offered to see an additional patient in order to help finish the day’s work, and typed my initials next to the patient’s name on the large electronic schedule board in the doctors’ workroom before heading down the hall to meet the patient.  But when I walked into the exam room and introduced myself, a mother and her daughter stared back at me silently.  I tried again, but when the mother nudged the girl and said something rapid and incomprehensible to me, I sighed.

“Español?” I asked.  They nodded.  “No inglés?” I asked, just to be sure.  No, no inglés.

A nurse had already paged a translator, so I returned to the doctors’ workroom to wait.   One of the two attending physicians commented that it had been a speedy visit, and I explained the language barrier.  The two looked at each other.

“Do you want me to take it?” one asked.

“No, it’s ok, I’ve got it,” the other assured, rising toward the door.

Both spoke fluent Spanish.  The translator was cancelled and clinic finished soon after, with no help from me.

And I remembered what was perhaps the main reason that all of my previous attempts at Spanish had fizzled: because it will take so long to ever finish, or even to make substantial progress, in learning a new language, especially when the task of learning medicine still looms large.  Because greeting a patient and exchanging pleasantries in another language isn’t the same as conducting a full encounter in that language and does not relieve my dependence on a translator.  Because these thoughts’ defeatist nature doesn’t make them any less true.

I skipped the Spanish lessons for a few days, but eventually tuned in again.  I don’t know how far this latest attempt will take me; perhaps it’s best to avoid dwelling on it, to just keep hitting “play.”  Last week I learned the colors.  I can say, “I live in a big yellow house.”  It isn’t true or even that useful.  But it’s something.