I knew I wanted to be a doctor when I was about 4 years old. I can’t explain now how I came to that conclusion or why I was so sure. I just knew and now I am a doctor. In my 2nd or 3rd year of medical school, as part of career guidance we were given a link to a website where we could input our data and get a psychometric analysis done on us. I had to answer a series of questions about how I felt about certain things, my beliefs, my principles, how I solved problems. Eventually, I answered the numerous questions and it took a minute or 2 to load. Then it gave me the list of medical specialities ranked according to the ones I am most suited. Pathology and neurophysiology came last as I would have expected but I was taken aback by the top 3 choices. It said: Paediatrics, Palliative Care and Neonatology. I poo-pooed the test and dismissed it. When I went into medical school, one thing I was certain of was that I loved children and I never wanted to see them sick and suffering. Therefore I sort of ruled out paediatrics very early on. Back then I thought I might end up being in Obs & Gynae (obstetrics and gynaecology) because it was a good mix of medicine and surgery and I thought the variety and acuteness would suit me. I also thought I could be a GP because it retained the versatility of all of medicine without having to make a choice.
During my Obs & Gynae posting as a medical student, I found that although it was interesting the speciality did not set my pulse a-racing. There was no eureka moment. The specialists were nice but I didn’t feel any kinship with them. My paediatrics was my last medical school posting and the moment I stepped into the Children’s Hospital (BCH), I felt an excitement. Even though most of it went over my head and there seemed to be a lot of calculations and there was the issue of small people who were not well, I felt right at home. Over the 6 week placement, I grew to love BCH. I loved the patients, the child-friendly wards with their play areas, the kindness of the nurses and most especially, here were doctors I wanted to be like. Who I enjoyed spending my time with. Who seemed to derive pleasure from their work even as they were rushed off their feet with the number of patients. By the end of that placement, the career puzzle for me was solved. I was going to be a paediatrician. And to my surprise, the patients I loved spending time the most with were the little premature babies born with complex problems needing surgery to survive.
As an FY1 (first year after graduation from medical school), I met a patient in her 30s who had inoperable incurable ovarian cancer. We bonded as I tried hard to get some blood out of her for some tests her consultant had ordered. When the ordeal was over, I thanked her for being patient and she called me back to say she thought I had a way about me that would be perfect for palliative care. She said she didn’t know if I already had my career mapped out but that I should think about going down the Palliative care route. I thanked her for her kind words and left in a reflective mood. Despite my psychometric prediction, I had never given it much thought. I considered it over the next few days and concluded that although I was a listener and when it came to my patients very patient (unlike in my personal life then), I wasn’t sure I could handle all the emotions that are linked with patients who are dying. So I filed the idea away under ‘unlikely’ and didn’t give it any more thought until just recently.
Earlier this year, I stumbled across an online course on paediatric palliative care and signed up to it. As I worked through the course modules, I realised that I was into all the issues that were being raised and although a lot of it was challenging, it was exactly the kind of challenge I relished. A lot of it was to do with talking about options and choices. About spirituality and counselling. About co-ordinating care. About letting the dying patient and their relatives dictate the terms about how these last days/weeks/months should be handled. I realised that palliative care is not just about the advanced care pathway which outlines what to do when death is imminent but also about actively keeping the patient well enough to reach certain goals. It is about enabling the patient to die in a way that is most acceptable to them. It is about being there for the patient and their family so that when things become scary or unexpected, there is a comforting presence to guide them through the darkest hours/days. So I have come full circle and now I know that I would like to sub-specialise in paediatric palliative care. I wish I knew where my Obs & Gynae patient was so I could share the news. I wonder if she is still alive today.
I love being a paediatrician by the way. If I don’t end up sub-specialising, I would happily be a general paediatrician. There is a different vibe on a paediatric ward or in a paediatric hospital like BCH. There is a friendliness that is missing in adult medicine. People seem to go out of their way more to be helpful in the paediatric world. Nurses do not seem to be as difficult or as disconnected as they can be in adult medicine. The paint on the walls is brighter happier colours. There are toys, music and games everywhere you go. The best bit about my job is the children. It is such a privilege to work with kids. They are amazing little packages, mostly untainted by the negativities that come with growing up. They come out with the best statements and questions that make you stop and think or laugh until your belly hurts. Their bravery is comparable to none and watching them as they struggle with illness and develop ways of coping is inspiring.
Of course paediatrics is a complex speciality by its very nature. Our patients are often too young to tell us how they feel and exactly what their symptoms are so we have to be more observant than our adult counterparts and we have to go on what other’s (parents/carers) impressions are more than the patient’s own words. Many do not understand why they feel poorly. They just know that they are not happy and they want it to be fixed. Parents are often not at their best when they meet us because they are anxious and stressed about their sick child and are frustrated because they have no solution to put them out of their misery. So yes, it is often the most difficult part of the job having to face irate upset parents who want to find someone to blame for their helplessness. Who want to take out their frustrations on someone else and make demands because it makes them feel they are doing something…anything. Sometimes, these parents do cross the line of anxious and stressed parents to parents who are abusive (mostly verbally but occasionally physically). Unfortunately, it comes with the job but we deal with it in our own way. Usually by being patient and reasoning with but where necessary we call on services to support and protect us. Luckily, these horrible encounters are not an everyday occurrence.
I have so many examples of the beautiful little people I have come across in my job but I will tell you about a recent one. I was on-call over a weekend and covering the haematology ward (haematology deals with diseases involving the blood cells). A 2½ year old boy with severe haemophilia B came in with bruising which meant he needed an injection of factor IX (the bit of blood he doesn’t make enough of which is essential to prevent you bleeding without much force). It was my job to treat him so with his parents and a fellow doctor assisting, we held him still and I injected the medicine into his vein. He cried as I did it and when it was done (it only took a minute), his parents prompted him to say thank you. Through his tears, he turned to me and said ‘thank you’. Then as I tidied up, they got their things together to leave and he waved and said to me ‘bye lady’. With no resentment. Despite the fact that I had just poked him with a needle for reasons he was too young to understand. I thought wow! Only a child would be as forgiving as that. The momentary feeling of guilt for making the gorgeous little boy cry passed with that exchange and off I went, to do more things to other children which might make them cry in the short term but looking at the bigger picture, everything I do is in their best interests so when I go home and I go to sleep, I feel happy and satisfied. And thankful for another day where I have done all I could to make another child’s life that bit better.