The Children

"History will judge us by the difference we make in the everyday lives of children."

                                                              Nelson Mandela (1918-2013)


For the most part, the specialty of Pediatrics is a joyful one.  Those of us fortunate and honored to practice it are met, on a daily basis with humor, wide-eyed curiosity, authenticity and honesty.  Lucky are we who earn the trust of families as we guide them through the nurturing and growth of a young life towards becoming a responsible and healthy adult, hopefully, one with competence and confidence.  Getting up in the morning knowing that, for the most part, this will be your day reminds me of the words of that famous pugilist and philosopher, Muhammad Ali: "Children make you want to start life over!"

Getting to know a newborn in the Special Care Nursery in my early days

The joys of holding an infant and watching it respond socially with a smile or a gurgle, hearing a toddler begin to converse, watching a child start school and an adolescent discover themselves and formulate a plan for their life are experiences we pediatricians treasure.  For years, I wrote down little quips I heard kids say that were either touching or uproariously funny.  Obviously, there was a price to pay to enjoy this work.  For me, it was 35 years of night call with phone calls in the middle of the night, trying to wake from a deep sleep to handle fears as well as true emergencies.  There was the vigilance required to do the best by my patients by careful listening and contemplation.  And there was the ever-present quest to stay up to date and absorb new diagnostic skills and treatments....but it was all worth it.

Joy!

There are just too many stories I could cull from 40 years of medical practice...some make me smile and even guffaw, some bring tears to my eyes with painful memories that have long been stored in the recesses of my mind.  I'll start with the humorous ones as they are the most facile to share with my reader.

It had to be about 2 am and, I was tight asleep.  This was back in the days when we would actually run to the office in the middle of the night if a cry for help necessitated it.  It was a Mrs. Smith calling, the answering service relating that they were one of my families.  I responded very quickly as it sounded urgent.  "Hi, Dr. Mayer.  This is Mrs. Smith calling about Suzie.  She appears to be quite ill, is not eating, and seems fatigued, is drooling and lethargic."  A drooling, lethargic child not eating quickly lit up my alarm and I agreed to meet them in the office.  Before I hung up I asked one more question. "Mrs. Smith, is she one of my patients or one of my three partner's?  I don't seem to recognized her name. (Despite my having about 2500 patients, I knew each and every one of them by name.)"  "Oh, yes, Dr. Mayer, she's been coming to you since we've had her (an unusual thing for a parent to say, regarding their child as a possession!)".  Just before I hung up to get dressed and get in the car, she added, "you know her well...she's our beautiful six-year-old Siberian Husky!!!)  The back story of this was that there was a veterinarian, Dr. Mayer, who subscribed to the same answering service as my practice and the operator got a little confused at 2 am!  She was re-directed to the vet and I, smiling, went back to sleep.  The next day as I was relating this to one of my partners, she told me that a month before, she had actually gone to the office after hours to meet a dog!!!  I guess this was my "All Creatures Great and Small" moment.

When I was just starting out as a young Attending Physician at Strong Memorial Hospital, the Department of Pediatrics was very keen on involving us in the teaching of residents and students.  To the end, many of us co-rounded with full-time Pediatric full-time faculty.  I, to my good fortune, was paired with Dr. Elizabeth McAnarney, familiarly known as "Lissa" to one and all.  She was one of the most highly respected Adolescent specialists in the country, well-published and just a wonderful person.  She would go on to become the Chair of Pediatrics.  I frequently bump into her in the halls of the medical center and she always reminds me of the time we rounded together.  The patient that stood out during that month was a young Hispanic teenager, newly arrived in the US, who presented with a bizarre paralysis of the entire right side of her body from her face to her feet.  As my mind went down the differential diagnosis, I realized that, neurologically, it didn't make much sense.  This had to be a conversion reaction!  But why?  Lissa, in all her acquired wisdom, had a suspicion that dealt with the cultural history that I never would have considered.  This entered what one would call a folk illness.  This was my one and only encounter with "Mal de Ojo", a hex cast on children, unconsciously, that is thought to be caused by the admiring gaze of someone more powerful.  A quick call to a Latino physician explained it all to us, with a resulting folk cure and a happy ending.

Not to take away from Art Linklater, but kids do say the darnedest  things.  I started to write down some of the cute and hilarious comments that would come out of children's mouths.  And then I started to collect some of the many letters from them and their parents over the many years I was in practice.

As with all things, there's a duality in medicine, a yin and a yang, if you please.  For many of the happy moments and successes, there is also tragedy and hopelessness.  These come in the form of accidents, terminal illnesses and unexpected and harmful events.  For many of these, we use all our skills to mitigate or, at the least, to prevent.  The accidents got to me as I always sought how one might have prevented them, particularly drownings and pedestrian/car accidents.  There were also diseases that we might not yet have had a cure for.  A pediatrician is only supposed to diagnose 1-2 cases of leukemia.  Over a course of 6 months, early in my career, I diagnosed 3 of them. Fortunately they all went into remission and eventually cure.  It was odd because all 3 had father's who worked for the same large chemical company whose name will not be mentioned here.  Thinking I had a cluster, the health department didn't give it credence.  And then there were the genetic diseases for which no cure was available.  One lovely family lost an adopted child to one, only to have a subsequent adopted child die from SIDS.  How much pain can a family take?  It was times like that that showed me how resilient the human spirit can be.

A hemangioma (a birth mark that eventually fades) in the perfect shape of a heart!

Two of my "babies" that outgrew me!

I bumped in to a former patient at a college graduation.

But looking back, I never regretted having chosen this amazing specialty with all its ups and downs, knowing that I was helping children and families.  As I tell my medical students, Pediatrics is an open door for so many pathways...public health, sub-specialties, research, teaching, journalism, epidemiology, child advocacy and even politics!  I was delighted last week to see the first pediatrician, a women from the state of Washington, elected to our Congress.

Dr. Kim Schrier, the first pediatrician and the only woman physician in the new Congress!