A Day in the Life of a PEM Fellow

I look down the signout list in preparation for the day.  My heart sinks and I feel myself sweating.  Palpitations ensue and I have to stop and take my pulse and an aspirin.  No, I’m not having a cardiac arrest.   At least not yet.  The patient in room 1 stole that thunder already.

Am I back in the adult ED again this month? Nope! PICU is the flavor of the month!  Back into the world of rounding for hours on every system of the body, discussing vent settings, sedation drips, whether or not to diurese, whether or not to feed, whether or not to extubate;  and yet all of those things are not why I opted out of doing a PICU fellowship. The medicine is great! I love a challenge, and these patients are certainly not disappointing me in that way. I am in way over my head and being inundated with a dictionary of words from a language that I have not used in several years.  So why the heck am I so exhausted when every day is a steady adrenaline rush?

It’s because in the PICU, work doesn’t stay at work.  In the PICU, these families and the patients become part of my life, and I become a part of their family. I am there when they wake up, and often I am there when they are preparing for bed. I am there when they go through some of the most poignant and sensitive times of their lives. I devote all of my energy and every fiber of my heart to them, especially when they have no energy left to propel them forward to the next day. I hurt when they hurt. I rejoice when they rejoice. I mourn every setback and celebrate every success.

I gave one chunk of my heart to the infant in room 1, who arrested due to obstruction in her airway from severe laryngomalacia secondary to removal of a neck teratoma, and to her parents who struggled with the decision to put in a trach.  I just sent her to the floor after getting her trach, and cried tears of joy when her mom got to hold her in her arms for the first time in two weeks, without any respiratory distress or endotracheal tube.

Another chunk of my heart went to room 12, who literally needs a chunk of my heart to replace his infected bicuspid aortic valve, who is getting a new valve as I type.

The baby in room 18 has a mom who buries her sobbing face into the scrubs of every healthcare provider who enters the room, and I can’t blame her.  At 3 weeks of age, her child was diagnosed with infantile ALL and underwent bone marrow transplant at 4 months. She gets a huge chunk of my heart, as I cannot imagine finding out that my newborn needed to have his blood volume pheresed and then have his entire body blasted with chemo to replace all of his marrow.

And I just want to hug room 20.  She has been dealt an awful hand of cards, but keeps playing the deck and avoiding the joker.  Her deep brown eyes rip out what’s left of my heart. I want to take all her pain and illness and disease away, but I can’t, and nobody can. The teenage years are hard enough without having to lose your mother and your health at the same time, end up on ECMO and dialysis, develop pancreatitis, and clots in your arm and lungs as well.

Then, at the end of the day, when I have nothing left of my heart to give, it is fitting that a cardiac baby fills the void whose contents I gladly sacrificed to the other patients. She is a success story. She was given a second chance at life and is thriving amazingly well.  Her long eyelashes, pink chubby cheeks, and soft baby coos in turn revive me, so that I can come back in the morning and do the same thing all over again.

So, no, I am not a strong enough person to dedicate my life and training to the patients in the PICU.  I can’t separate myself from them.  (Check mark next to career choice confirmation!)  But for this short glimpse of time, I am thankful every day they allow me to learn from them, to treat them, and to participate in the most vulnerable times in their lives. I am also thankful there are MANY people who do the work to fix children after they arrive in the PICU.  And I am happy to let them have that job when I go back to the Children’s ED in two more weeks, with a sigh of relief and a heart bursting with fulfillment.

Special thanks to:

Christyn Magill, MD, FAAP
Pediatric Emergency Medicine Fellow
Division of Pediatric Emergency Medicine
Department of Emergency Medicine
Carolinas Medical Center
Charlotte, NC

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