When I arrive at 8:30 am, the team is already behind on their work having had to send the kids to the PICU. This is not how I wanted to start my first night of call for Heme-Onc. As we scramble to catch up and sign out, the time flies by.

At 5:00 pm, I finally get a chance to sit and think about lunch. It's been a busy day, but only it was a steady stream of work, nothing too overwhelming. The patients on the floor haven't been causing too much trouble, and there's only been one patient admitted; We'll call her Amy. Amy is 4, has a brain tumor and unfortunately the prognosis is grim. On a recent admission, just a few days before, her mom signed a DNR order. She comes in today unresponsive, but breathing from on outside hospital. When I see her she only responds a little when I rub her chest. It turns out that her sugars are high (>1000!). While she may not have much time left and she may be DNR, I think we can treat this and she could wake up. Mom repeats that just yesterday she had been walking and talking. I'm already worried.

It's 10:30 pm and we're finishing night rounds. We've checked on all the patients - 20 kids tucked and ready for bed. Just as we're finishing, we hear from one of the nurses that there is a patient in the ER likely to be an admission. As we're about to go the ER, Amy's nurse come up running out her room to ask if we can come check on her breathing. We had just seen her minutes before and she looked comfortable but breathing a little fast.

We enter the room and another nurse is suctioning her trach. Putting my stethoscope to her chest, I listen for breath sounds. Nothing. I move to the other side. Again nothing. I look up with fear at the nurses. I was just in here. She was breathing then. They continue to suction. Still nothing. No heart sounds either.

Mom is sleeping in the corner. We tell the nurses that we need to wake up mom. I continue to listen. I don't know how long it's been, but I feel like I've been listening to this silence forever. I can hear mom saying she was just walking and talking yesterday. She wasn't ready. How could she be? My senior looks at her watch. Amy is dead.

More nurses have come to help. They move with such a purposeful poise. They remove all the lines and plugs from Amy and clean her so that mom can hold her child one last time. Someone is covering the door so no one can look in. I'm standing on the side. Awkward just staring at mom searching for words. As she sits in the chair crying I try to think of something to say. Anything. Why have I gone blank? They even make us practice for this very moment in medical school. I thought I was ready. But I'm not.

I sit next to mom and place my hand on her shoulder. I opening my mouth just to close it again. She wants to be alone, so we all leave the room.

It's 11:30pm and now we have three patients in the ER. It's close to 4 am by the time I'm finished working to admit the new patients. By the time I back on the floor, I see they are cleaning Amy's room. I missed it all. Amy's mom has left with her family. I'm tired, but more than anything I feel defeated. I still don't know what to say, but I know I wanted to say something. But my chance is gone. I'm not sure what scares me more - that I won't know what to say again next time, or that I'm pretty much guaranteed a next time.

Question for Patient, Physician and Society

Q: Write about the challenges you face—as well as factors that help you—in maintaining empathy while practicing medicine. Give examples of patients or circumstances where you have found it particularly easy or difficult to maintain empathy.

A: When thinking about empathy, I decided to look it up in the dictionary just so I knew exactly what I was talking about. I don’t like thinking I know what I’m talking about, when in fact I don’t know what I’m talking about; you know? So I looked it up hoping that I would find some more information on empathy that might crystallize the question for me.

Dictionary.com Unabridged (v 1.1)
em·pa·thy (em-puh-thee) n.

1. the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.

American Heritage Dictionary
em·pa·thy (ěm'pə-thē) n.

1. Identification with and understanding of another's situation, feelings, and motives. See Synonyms at pity.
   
2. The attribution of one's own feelings to an object.

Jackpot. I often put a lot of feelings into objects. My stuffed animal collection, which sits proudly on my bed slightly over flowing onto the self next it, is filled with my own feelings or at least something like them. Mr. Pickles, a small furry frog with a precocious bow tie, is especially filled with feelings. Whenever we talk to each other I find myself having to watch my words. Almost anything I say will send him into tears. He's such an emotional frog. But I supposed I can understand why. He lost his matching female frog (dressed in a fetching pink tutu) in the freak washer/dryer accident of 2002. It’s that kind of tragedy that anyone can understand. I can imagine myself losing my soulmate would be crushing. I think that’s what it boils down to. I can empathize with Mr. Pickles because I can see where he’s coming from. I can put myself in his place and at least attempt to identify with his situation. But Mrs. Pokey Bear, she’s just a diva.

The time has come to toast our friends along,

With cheer and mirth we sing the Match Day song!

Lalalalalalalala~

It's match day today, and like all medical students all across the country, I learned my fate today. The day started at Gino's East. We all gathered at the third floor party room. The sealed envelopes were handed out along with poppers. Just before noon the countdown started and amongst a stream of confetti and poppers we opened our letters. I struggled with he envelope has I heard a steady stream of cheers behind me. But I was dazed. Even as I unfolded the papers, it seemed as if I were moving in slow motion. But finally I saw it, Children's Memorial Hospital. Here I come. Woot.