“You’re going to fall in love with her,” the nurse warned me, as I stood outside my eleven-year-old patient’s room ready to wake her up for surgery pre-rounds at 5:30 a.m.

I offered back a tired smile and knocked on the door timidly. “Naomi?” I whispered.

To my surprise, I was greeted with a chirpy “Good morning!” and entered the room to find a bright-eyed eleven-year-old sitting up in her bed with all the lights on, carefully crafting a pizza out of a wide assortment of Play-Doh toys.

I glanced around the room briefly and found the extra bed in the room, typically reserved for parents/guardians, completely untouched. In my prior experiences with pediatric patients this young, I was accustomed to greeting the child briefly and then deferring medical questions and assessments to the parents. As this was no longer an option, I hesitantly turned to Naomi.

“Do you have a parent here with you?” I asked.

“No,” she replied, “my mom is too busy working to stay here.”

“OK,” I improvised, “Well how are you feeling?”

To my astonishment, in anticipation of my typical surgery pre-round questions, she responded, “Well, my bag put out 300, I haven’t thrown up, I farted, and I don’t have any belly pain. Oh and no fevers.”

I smiled. “So you’re pretty used to being here, huh?”

She nodded. “Now are you going to eat this pizza or what?” she exclaimed, handing me her latest creation.

I quickly learned that Naomi was no stranger to the pediatric surgery service — she was born with gastroschisis, a congenital disability where her intestines were found outside of her body. Though her gastroschisis was surgically repaired, she was left with short gut syndrome, a disorder of malabsorption secondary to the removal of a significant amount of her small intestine, and a colostomy bag that collected her bowel from what was left of her colon. Three years later, Naomi had returned to the hospital severely malnourished and had spent months on the floor as she was quite literally nursed back to health. She was back now because one of her many catheters had become infected.

The nurses and attending physicians called Naomi “mayor of the floor,” and it was easy to see why. Beginning at 6 a.m., she ran around the floor, IV in tow, checking on the other children. She helped the nurses change the infants’ diapers and blankets. She stashed graham crackers in a pouch and distributed them to the nurses and staff members, once handing me a packet and telling me that “I looked like I needed a snack.” When I found her at the nurses’ station at 5 a.m. one morning, she grinned widely, exclaiming, “Look, I’m hanging out with my friends!”

When I tell people that I am interested in pediatrics, I am often met with a response of, “Oh sick kids, that’s just too sad, I could never do that.” I have always understood this sentiment. There is a heightened injustice of pure and innocent children afflicted with intense suffering that I believe ignites a fervent anger and sorrow in us. After spending a few weeks working with pediatric surgery patients, many of whom were also cancer patients, I was startled by my ability not necessarily to suppress those emotions but to bury them beneath the logical flow of “Well, what is the assessment and plan for this patient? How do we proceed from here?” As the days went by, I grew afraid that I was losing the emotional depth that had drawn me to pediatrics in the first place.

Naomi’s ardently bright light, and my profound adoration of her, clarified to me that I had not lost my personal connection to pediatrics — rather, I no longer viewed these patients as objects of pity or commiseration. I more deeply believed in their ability to illuminate the brightest and most sacred aspects of our human conscience.

I once asked Naomi why she was always awake so early in the morning, to which she remarked: “Well the early birds always find me and wake me up in the morning.”
I chuckled, and continued, “Well, is there an explanation for how you’re always so happy too? Even when you’re sick?”

“Oh, that’s easy,” she responded, almost immediately. “Every day, I find the happy birds. It’s easy to find them if you look for them.”

The palpable sorrow and heartbreak of medicine have been plain to me in the first few months of my clinical rotations and especially during my weeks on pediatric services. At times, this sorrow has felt overwhelming and asphyxiating, but Naomi’s reminder to “find the happy birds” rings true. Many of us enter medicine with the desire and expectation to help people and save lives — the harsh injustices we encounter often force us to redefine these goals and to recognize that much of our healing requires us to simply counter helplessness with unrelenting love, even when the cure for an ailment is beyond our reach.

“Finding the happy birds” is not merely a survival skill — it is a reminder that our work has value, and that whatever field we choose, we must constantly reaffirm these values. My pediatric patients’ remarkable optimism and purity inspired me. They reminded me not to shy away from sadness. They motivated me to serve them with more happiness and more love in a confusing world where my role as a medical student is often unclear.

I did not get to say a proper goodbye to Naomi before she was discharged, and will admit that I was struck by a sense of loss when I returned from the OR one afternoon to find her room empty. I turned to the nurse – “So, Naomi went home?”

She nodded, “I’m going to miss that one. In typical Naomi fashion, she was laughing uncontrollably on her way out.”

I smiled. Of course, she was. She found the happy birds. Like she said, they are everywhere.

Prerana Chatty is a medical student.

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