-I will be on a leave starting today so I won't be able to see you for the next month- so tell me sweety who do you want to take care of you when I am away ?
- I want you
-mmmm I told you I won't be here ....but look I will let my friend take care of you during my leave...he is so good and sweet and I am sure you will have great time with him
-are you sad sweety ?
- I don't want you to go
-look I will bring you something when I come back ...so tell me what do you want
- a doll
- fulla ?
- yes fulla
-ok you got it !! are you still sad ?
- sure ?
that was a poor 5 year old girl with leukemia in non remission and aspergillus filling her lungs....that was my goodbye conversation with her before I sign-off her and go on my annual leave for good
besides her I had another 4 patients and all of them where terribly sick...a poor boy with burkitt's lymphoma and a very resistant bug swimming in his blood making him febrile around the clock ...a very smart 17 year old with AML on tons of antibiotics and a platelet count that refuses to go up no matter how much you transfuse him...another poor 9 year old boy who has ALL and undiagnosed disaster in his abdomen ...and that poor girl with seizures and brain tumor....and I had to pass their care to other doctors on duty....
I listened to long boring instructions from the chief about the importance of sign off notes and how detailed and informative they should be...I sat down in the office , plugged my ears with my earphones ...took out my daily progress note from the files ...printed out every single piece of info in the electronic record and started writing ....I mentioned everything : from presentation to complications to lab tests...I included every single dose of antibiotics...every single dose of CTX ....patterns of labs...cultures ..everything day by day...followed by a summary of the condition of each system and a detailed long and short term management plan ...it took me a whole day and a right hand that is still aching despite all NSAIDs in the world to write down those 30 pages or so...I thought that the most difficult part of the process is done ..but Poor Hashem..he was terribly mistaken
the next day I signed off my patients to another doctor...passing their care to him...put off my white coat...hanged my stethoscope in my locker...carried my bag...went to say good bye to the kids...just to discover that they were really sad I am leaving !!! in fact I never thought that they got attached to me ..to my daily rounds on them ...to my quarrels with their caregivers when they fail to follow instructions ..to my stupid jokes and to the fact I was the only doc who examined their throats without a tongue depressor !!!!
once I was outside I started to miss them and worry about them !!! I really felt such an ache in my heart that I didnt stop calling the resident and the fellow asking about them...even suggesting plans of care !!!!(she needs a central line....why don't you start him vancomycin ...don't forget dude she has a lung biposy tomorrow ..Keep her NPO !!!! make sure that the boy whole body CT is done before Wednesday .....)
it is strange how you get attached to your patients without knowing and then discover that too late ....I felt really terrible today ... I felt that leaving them in the middle of their suffering was kind of letting them down.....especially when they are really sick and I was never sure if they will be alive when I get back.....
Don't get emotionally involved with your patients ....for pediatricians ..this will never work