This story happened a long time ago. I think I've written it online before, perhaps as a Twitter thread that is now long gone. I've rewritten the story here because I think of it often and wanted to be able to share it.
When I was an ICU fellow there was a night shift where I'd been out of the ICU for a week or two and wasn't overly familiar with all the patients. I came in and got sign out and checked in on everyone. Handled things as they went along. Sometime near midnight when there wasn't anything actively requiring my attention I did what I always did and went around and checked in with each nurse.
Discussing one of the patients, an infant with a severe congenital problem whose solution was failing, the nurse expressed to me her sorrow that we were keeping the child alive just to keep the parents out of jail. I knew this nurse well and it was such a bizarre, jarring thing to hear from her I asked what she meant. She was shocked I didn't already know the context. When I asked what it was she told me to just google the child's last name. The conversation got stilted and I moved on to my other patients.
After finishing rounds I had time to lay down, but I had taken a nap before my shift and wasn't tired so sitting at my computer I googled the family's name. The first couple results were all about the child abuse allegations and impending trial against my patient's parents, but the allegations didn't include my patient, but another of their children. I don't have words for the feelings those allegations engendered in me but the closest are enraging, infuriating, wrathful.
I spent the rest of the night mad that the world could let children be so mistreated and furious with the perpetrators and enablers. I also spent the rest of the night extremely angry with myself.
When I was young(er) and dumb(er) and a medical student I had done a rotation at the hospital that served a large prison complex of both state and federal prisoners. The state prisoners were on a different floor with a different medical service, but the federal prisoners were on the general med/surg floor and cared for by our team. One day an intern and I were idly speculating about what crime a particular patient had committed. Our attending overheard us and angrily interrupted us telling us both, in a tone that brooked no argument, "Never ask that question. The answer to it will never help you take better care of your patient."
I had remembered that lesson and mostly abided by it; being a pediatrician helped. My patients were rarely the barbarous ones, it was usually someone around them. Another attending, during another tragedy, had taught me to, when caring for abused or mistreated children, focus on creating the most caring and loving environment that I could rather than on the terrible things that happened outside it. The frameshift helped me immensely through the subsequent tragedies that came into my care. I still teach that re-framing now that I am the attending.
Back to my night in the ICU though. I was angry with myself because I had known that my google search wouldn't help my patient in any way and in fact it may harm my ability to care for the child and family with compassion. I'd given in to my own morbid curiosity for nothing except a sense of righteous anger that helped no one. Truly the definition of a negative-sum endeavor.
The rest of the night shift went by and there was enough that happened that I never got any sleep but I wasn't busy enough to stop thinking about the google search. I went home and eventually managed to get some sleep before going back to the ICU for the next night. It went by much the same except that when I did my late night rounds the same nurse had the same child and she asked if I'd looked it up. I admitted I had.
She expressed how wrong it was that we were keeping the child alive just so that the parents could push the trial off longer. I expressed how mad I was at myself for having read about the allegations and how upset I was that people were presuming the only reason the family hadn't let their child die was to forestall justice. Our impressions of what was happening and why were so wildly different it was hard to recognize that they grew from the same set of facts.
The nurse's perspective that I did not adequately consider then was her hour-to-hour, day-to-day experience trying to manifest that impulse of love and compassion that I talked about earlier. In her care was a child whose life was supported by all the implements of modern medicine, lines and tubes and drains, none of which are comfortable to endure. Her job was to palliate suffering, but for this child there was no therapy sufficient to that end.
Across our philosophical divide I couldn't believe that the grief I saw and heard from the child's parents was not genuine. Perhaps it's naïve but if I see grief like those parents showed and disbelieve its authenticity I will know it is time for me to retire from caring for patients. Within those parents I saw people who were terribly, terribly flawed but I also saw that despite their flaws they felt tremendous love and grief for their dying child.
I don't know what the moral of this story is. I know that I think about it whenever I get the sense that a person, or a group of people, are being portrayed as not deserving our compassion.
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