Peds

Its day 5 of ceftriaxone and vanc, hospital day 6 for perostinal abscess in the lft distal femur s/p I and D, POD 4 for appropriately developed 14 year old is what her chart says. But to the pretty 14 year old with big expressive eyes, It’s Sunday…”I WAS gonna get baptized today, Momma got me a white dress to wear.” she tells me. “But now I am here.” She sighs and looks longingly out the window of her hospital room. For our counting of milestones it seems we have missed one.

Its day 14 of the second of 8 chemotherapy protocols, POD 0 for a port-a-cath insertion for a 3 yo well developed female with ALL. I finish my presentation and we walk into the room. My resident goes and sits down on the bed next to the petite three year old with a million dollar smile and a beaded crown cocked slightly to the left on her head. “You finally have your port” she says. “No more IVs.” The three year old raises an eyebrow, Its not a PORT, It’s a PORT-A-CATH” she says as if she explaining something complicated to a small child. “And it’s beautiful and I love it, today is a special day.” Indeed, another milestone perhaps not one that I check for on my development assessment but momentous never the less.

Its day 6 of methotrexate for a 17 yo with relapsed ALL. On exam her mouth is filled with erythematous white plaques and she is febrile. She lies in bed speaking in whispers. Her eyes are red and inflamed from the chemo and from crying.. Today is a milestone. Today is her 17^th birthday. We sing to her and she offers us a rare smile. I spent that afternoon, my last afternoon on peds painting pictures with her. I doubt it was how she imagined her 17^th birthday would be. But her smiles and paintings are beautiful and I treasure them. For a little while we transcend illness and I know she treasures that.

Milestones, we count them, we test them, we watch for them with great anticipation. We celebrate them with joy and pride as parents and with a smile and a check in the box as clinicians. Can she crawl, can he draw a circle, can he hold a rattle, can she drink from a cup, can he walk, can he say his full name while hopping on one foot and singing a song?? We are quick to note when a milestone is not met, prompt to seek out the appropriate intervention. When a child is ill, still there are more milestones. We count off the antibiotic days, the number of chemotherapy protocols, weeks in cast for a fracture to heal and post-operative days with great flourish and precision. Days, Months, years of a child’s life counted off easily roll off our tongue at rapid fire.

But in all our counting and documenting, we have to be careful to stop, to savor, to celebrate them. We also have to fight for them. One of the things that struck me the most on peds is that children with chronic illnesses have to fight for their childhoods. The Medical drama can consume their lives and force them to grow up so fast. The least we can do for these kids is let them be kids and not let their medical milestones and protocols monopolize their lives.

PS: Peds was awesome. The end.