Medicine can wear down our hearts and souls.  My journey in pediatrics has been filled with many rewarding experiences but haunting ones as well, like this one from my third year of residency.  By that final year of training, I was no longer certain medicine was really the right choice for me.  I was struggling with the notion that after almost 11 years of education, the destination was not quite what I expected.  It was during this trying time I learned one of the most important lessons of my career:  the value of trusting a mother’s intuition.

My patient was a 6-year-old girl whose mother was sitting next to her bedside.

“Something is not right about my daughter; I would like you to do a blood count.”

I was not compassionate.  Frankly, I was so tired; I did not really care about her reasons for wanting the test.

“OK.”

I left the room to check the computer for prior visits, and a blood count had been done yesterday.  Yesterday, the result was normal.  I was incredulous.  I went relay the story and mother’s request to my attending at the time.  His answer was, “do another one and release her once the result comes back the same as yesterday.”

We were very busy that night.  I sighed, went back to the room, completed a cursory history and physical and let her know I would draw the blood.  I was probably short with her, condescending, and dismissive of her concerns.  I felt justified in thinking she was overprotective and could not possibly “know” what I knew as a physician.  Many years have passed since this experience.  I cannot recall the exact details of the history and physical, but I do remember nothing seemed unusual.  In all fairness, that could have been my closed minded perspective getting in the way.

An hour later, the lab called up to the ER with results.

“Leukemia,” the lab technician said.  My jaw and my heart hit the floor.

“What did you say?” I asked.

“Leukemia,” she repeated.

“How is that possible? The result of the smear was normal yesterday.”

She said, “We missed it, we went back and reviewed the previous smear, and that was abnormal too.”

I walked slowly back to that exam room and sat down with tears in my eyes and told this beautiful little girl and her mother that she had leukemia; the oncology team was going to admit her that night to begin the full evaluation and treatment process.  I felt terrible; not only for the diagnosis but also for how poorly I had treated this mother and her child.  She sighed and said she was relieved to finally know what was wrong with her daughter.

“I am so sorry.”  I was sorry for so many more things than I could say.

I have always wished to have the opportunity for a do-over.  In my ideal replay, I would walk in and take an extensive history and physical, discuss a list of possible diagnoses with mom, and draw the child’s blood.  I would express compassion for her and tell her it was going to be alright.  Despite having ups and downs during those three years of internship and residency, I learned many invaluable lessons during those three years.  I wish I could thank this mother now.  She taught me the importance of listening to the person who knows their child best, their parent.  It is a lesson I have never forgotten.

Niran S. Al-Agba is a pediatrician.  

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