When I chose a career in pediatrics, everyone had something to say about my decision. While most of my friends and colleagues were supportive, there were more than a few that just couldn’t understand why I would sign up for a lifetime of “ear infections and runny noses.”
Even among other medical professionals, it’s not uncommon for pediatrics to be viewed as a less-than-serious specialty. Maybe it’s the sea horses on the walls. Or the bow ties. Or the fact that we really do see a lot of runny noses. And to be fair, most of our patients aren’t all that sick, and many of them would get better without us. We field a lot of questions about choosing car seats, potty training, and making babies sleep. We handle concerns about school performance and behavioral problems. We explain to new moms why those little red bumps on their baby are really nothing to worry about.
And most of the time, even when things are scary to parents, we don’t get worked up. For instance, children will frequently have seizures caused by a fever. These are terrifying to parents, but medically-speaking, once we rule out the scary stuff, they’re usually not a big deal. Even a fever by itself can be scary to parents, although it’s almost always a non-issue. A huge part of a pediatrician’s job is sorting out the child with a potentially dangerous condition from the much larger volume of self-limited problems that will go away with time. Another crucial skill is the ability to explain to parents why they don’t need to worry—without downplaying their concerns.
The tricky part is that the differences can be subtle; we can’t afford to let down our guard. Because every now and then, kids get sick…I mean really sick. One of the most important things we learn early in training is to differentiate “sick” from “not sick”—those children who require urgent intervention versus those who—at the very least—can wait a bit. The ability to recognize a sick child and take quick and appropriate actions can mean the difference between life and death. And if we do our jobs well, they usually get better—even the really sick ones.
But sometimes, they don’t. Sometimes, pediatrics is talking to parents about an inoperable tumor. Sometimes, it’s discussing how to keep a child comfortable after our efforts to make him well have failed. Sometimes, it’s trying not to picture your own kids while working to save a child’s life after a catastrophic accident.
Recently, I took care of a young child who died tragically. I was explaining to his father the need for some invasive procedures that were necessary to slow the progress of his disease. I’ll never forget what he said: “He’s not mine. He’s yours now. Just do whatever you would do for your own child.” Because really, that’s what we should be doing all the time—for the runny noses as well as the serious issues.
While our adult counterparts deal with death on a regular basis, these cases are less common for us. The vast majority of our patients graduate to adult medicine and outlive our care by decades. Watching a child die is heartbreaking as a physician–unspeakably so for a parent. Hopefully, you never have to deal with anything of the sort. The most important thing you can do is find a pediatrician that you can trust to care for your child as his or her own. One that you trust to manage life-or-death situations, as well as a runny nose. One who knows when and how to reassure you, and when something more is necessary. Fortunately for us all, it’s mostly runny noses.