I wonder what the best thank you any physician has ever received?  I think this one is mine.  This recent thank you was for our efforts to not save a child but for simply allowing this family to have a few more days with their infant who ultimately passed away.  This amazing thank you has deeply and positively affected me so much that I thought it should be shared.

Nothing can offer insight into the challenging world of pediatric emergency medicine like this thank you.  Not just a thank you note but a gift basket filled with treats.  Pretty cool and a rare gem in emergency medicine.   What you have to understand is that over my 20 years thank you notes or gift baskets rarely come to the emergency department.   We occasionally receive a nice comment among complaints of long wait times in a patient survey but rarely receive any form of a written thank you.    We don’t work for a thank you but so nice when they come.  This one was beyond unique.

Thank you for a few more days.   Thank you for trying.  Thank you and your team and for all your experience and expertise is trying to save our child.   Wow.   A family grieving over their child’s loss takes the time and effort to thank us is amazing.

What most don’t know is what it’s like to work in a pediatric emergency department.  Our greatest challenge is a call from an EMS with a child not breathing or needing CPR.  The call comes, and our team mobilizes.   Emergency equipment is readied, and pediatric sizes are estimated.  A code cart full of medications and airway devices is brought to the room.   We all wait. Precious minutes pass as you prepare to see who, why and in what condition the patient and in what emotional state the distraught parents will arrive.

One’s six years of pediatric training, 20 years of experience and ongoing pediatric resuscitation refreshers flash thru your brain.   You mentally prepare to stay calm and focus on the problems and detach your emotions from the child before you and the upset family.  You focus all your energies on vital signs and response to medications, chest compressions, and airway maneuvers.   Can you feel a pulse?  If not, will you ever get it back?    You keep trying and begin to wonder for how long you should continue.    An amazing team of professionals, dedicated to caring for kids, are working in unison to try everything for this child   The pulse once lost is back, we have a blood pressure, and the airway is secure.  We all take a deep breath and begin to hope for recovery, but we know the odds are against this child with his pre-existing medical conditions and challenging resuscitation.

After 60 minutes of resuscitation, I now get 2 minutes to speak with the parents before the child is transported to the ICU.   Two minutes to meet, discuss, empathize and offer hope laced with caution.  I need to help the parents understand the critical condition of their child.   Despite my attempt at reassurance, I know the parents’ minds are left to wonder what we should have done different, what if or how did?

For the ED staff, no time to process or debrief, we have six patients now waiting to be seen and more ambulances on the way.    Ten hours left in our shift before we go home and try to process the event.   Intermittent updates from the ICU reveal little progress. For me, I spend my next several days hoping to hear good news.  I replay our work over and over.   I pray for the child and the family.

Unfortunately, several days later, the child dies.   I grieve and wonder why.   I pray some more.  I grapple with the impact on my ability to continue to resuscitate children and do this work.   The loss of child is challenging.

What a gift to me was this thank you.   Amazing, that a family amidst its grief, has the ability to reach out and thank us for our care.  The recognition not only or our efforts but that we too are parents, siblings, and people first is quite appreciated.   We go into this field because we love children and want to help them and their families.  We want to save lives.   With time we learn, cure isn’t always possible but caring is, and this note is a great reminder.

Thank you to this family for entrusting us with the care of their child and thank you to them for reaching out to us.  Their compassion in a time of their own incredible grief is quite remarkable and appreciated more than they will ever know.

Mick Connors is a pediatric emergency physician.

Image credit: Mick Connors