What I think about during clinic - part three

5. Children

Children are often such a clear reflection of a stable, or dysfunctional family. A little girl with neatly brushed hair and clean clothes, comes in coughing, politely covering the mouth with hands or elbows. Her mother is educated, concerned, but not overly anxious. A young boy comes in, with his alcoholic mother and father who can't keep a job because he often doesn't bother to rock up for work. The mother warns the doctor about how he may swear profusely whilst the local anaesthetics injection is being administered.

There are patients who really struggle with life. Then some have kids, and lots of them. It's stressful because sleep is disrupted, the kids need to be ready for school, somebody needs to care for them when you are at work, kids get sick frequently, and so on. If parents are barely managing to care for themselves, or have one unstable marriage or relationship after another, you can't help wonder, why have so many children? (I wonder sometimes for myself too, whether I have enough mental stability to be a parent.)

On a brighter note, I'm almost always more awake when I see a child. It doesn't matter what they come in with, even if it's URTI after URTI. I don't tire of playing peekaboo twenty times in a day or sticking my tongue out at the child (only if the doctor and parents are busy talking to each other). I'm happy to lend my stethoscope as a toy. I remember how five year old C always loved to listen to bowel sounds, then would pull up her own shirt and say with a sweet smile, "do you want to listen to my tummy?" Sometimes I want to pick kids up for a cuddle but I guess that's not really part of the job of being a doctor. I did once though, and quickly realised that I should be careful with my dangling earrings and hair that isn't tied back, as naughty little babies pull at anything they see.

For years I've always said that if I wanted to do paediatrics, I might as well have done veterinary science. Like pets, children are uncooperative, plus they scream, growl, vomit and even bite you. Before my children's rotation earlier this year I had the following conversation with C.

C: Children's hospital (reading my rotation timetable on the computer screen). Do you like kids?
W: No.
C: Aww, but you like me!!
W: Yes, but I only like you!

I guess that's not so true. Although C, I only like kids because you're such a beautiful, lovely, bright, happy, funny, little girl. I only like other kids, maybe because I really miss you when I don't see you for months and months.

6. Aging

When a child pouts and throws a tantrum, or lacks insight, it's acceptable. But in a full grown adult, or elderly patient, it's distasteful. Even if the maximal mental and emotional capacity in that person, is the same as a child's. Life's not fair, is it?

The circle of life is a running theme in general practice as you see children, teenagers, young adults, progress through stages of learning to walk, run, work, drive, live on their own, be married and have children. And in the same room you see the elderly, gradually becoming unsteady on their feet, losing their memory, unable to drive, being widowed, needing to go into care because they are no longer coping. An interesting medical interpretation of Ecclesiastes from a fellow student, which made me laugh when I heard it:

Ecclesiastes 12:3-5

...when the keepers of the house tremble, (unsteady hands)
and the strong men stoop, (kyphosis)
when the grinders cease because they are few, (less teeth)
and those looking through the windows grow dim; (sight)
when the doors to the street are closed
and the sound of grinding fades; (can't remember, stopping work?)
when people rise up at the sound of birds, (insomnia)
but all their songs grow faint; (hearing)
when people are afraid of heights
and of dangers in the streets; (fear of falls)
when the almond tree blossoms
and the grasshopper drags itself along (impotence)
and desire no longer is stirred...

From dust we came, to dust we return. Entropy, sickness and death overcomes all. And seeing that each day in clinic is unsettling and frightening, knowing that neither I nor the ones I love, can escape.

(continued from Eccl 12:5)
...Then people go to their eternal home
and mourners go about the streets.

But seeing life and death is also a constant, and perhaps a much needed reminder that this is not home. Which forces us to reassess how we're spending our short life, and about exactly what we're chasing. I fell in love with this song when I heard it for the first time recently, on the way to clinic:

...Cause what if your blessings come through raindrops
What if your healing comes through tears
What if a thousand sleepless nights are what it takes to know you're near
What if trials of this life are your mercies in disguise?

When friends betray us
When darkness seems to win, we know
That pain reminds this heart,
That this is not, this is not our home
It's not our home