Residency’s First Life Lesson

A Sensible Medicine Guest post

I still remember my first day of my pediatrics residency. It was such an exciting day; my first day as a real doctor, finally taking care of patients of my own. I was assigned to the “clean” floor which had a few quick in-and-out cases such as post-op appendectomies and fracture reductions, but was mainly patients with terrible diagnoses like severe combined immunodeficiency (SCID), dermatomyositis, and, most commonly, childhood cancers.

I’ll never forget my first patient, who I’ll call Marianne. She was a beautiful, smart 16-year-old with a brain tumor. By the time I met her, cancer had left her bald from the chemo, scarred from the surgery, and swollen from the steroids with trembling hands and slurred speech. But a picture in her room from before her diagnosis showed a vibrant girl with sparkling eyes and a long mane of dark, wavy hair. Her intelligence still shone through in conversation, and her family played word games with her to pass the long hours in the hospital room. Those games reminded me of my own family; we also loved word games.

Even as a new resident, I could see this was the end. Marianne was dying. What made it almost unbearable was that her family didn’t seem to know. I thought they were ignoring what the doctors said, clinging to every shred of hope because they couldn’t face losing their clever, pretty daughter with her whole life ahead. I didn’t feel it was my place to judge how they coped. I dutifully presented Marianne on morning rounds every day, reporting her vitals, her worsening neurologic exam, and how many milliliters of urine she had passed.

At the end of my second week, I started attending specialist rounds with her neurologist and oncologist. There, I learned that the plan was to keep offering the family more treatments, treatment that had no chance of working. No one had told the family the end was near. Marianne had endured failed rounds of chemo, radiation, surgery, and steroids. She’d gone from a lively teenager to a wheelchair-bound patient who couldn’t use the bathroom alone and was in constant pain. She was spending her final weeks in a hospital room instead of at home with her family.

I didn’t know what to do. I was a first-year resident, just weeks into training, with no real experience. The specialist attendings intimidated me, and my one timid attempt to suggest telling the family it was time to go home was overruled. So I kept rounding on Marianne twice a day in that sterile room, watching her decline as they gave her more treatments that only caused more suffering.

My moment of truth came when discussions about moving Marianne to the ICU began. That meantt no longer a private room, but instead a curtained off alcove, a place with no privacy or peace, where her parents couldn’t stay with her. There’d be constant medical noise.

I gathered my courage and asked her parents to step out for a short talk.

I told them Marianne was dying, and it would be soon. I said the medicines had no hope of helping, only causing more pain. I told them they should take her home and surround her with everything she loved for the time she had left. Scared of repercussions, I selfishly asked them not to tell anyone I’d said anything, but to ask the doctors more pointed questions about her prognosis and treatment goals.

Because of my words, the family decided to stop treatment and take Marianne home. She died at home less than two weeks later, surrounded by her family. They never told anyone what I said, and I faced no consequences.

This story does not have a tidy ending. I’m not even sure what I learned. I didn’t spend the rest of residency doing things like this. I’ve never told anyone about this experience. I still feel the sting of guilt for going behind the backs of my attendings. I still feel the terror of that conversation with Marianne’s parents. But my first patient is still the one I remember most. I still think about Marianne and her family. If I’d ever had a daughter, her middle name would have been Marianne. Writing this, three decades later, I still tear up, especially after realizing Marianne was only 10 years younger than I was then. Sharing this now feels like putting down a burden I’ve carried for decades, and a way to honor her memory and a difficult decision, even if I’m still wrestling with what it all means.

Marcy Henderson is a pediatrician who has been practicing in the beautiful Mojave Desert for the past 30 years, and is stubbornly clinging to her paper charts and phones without automated attendants. She loves being a pediatrician, especially now that her grown-up patients are bringing in their babies.

Photo Credit: Adam Cifu