Clinical Experiences – Oliver

Early in my first year of clerkship, I assisted in the delivery of a baby named Oliver. There was nothing particularly remarkable about Oliver’s delivery and his APGAR scores at one and five minutes were both normal. Mom and Dad were thrilled to welcome Oliver into their lives, and before long the new parents happily returned home. By this time, I was nearly done my rotation in Obstetrics and Gynecology and soon moved on to Paediatrics.

One night while on call, I received a consultation for a neonate in respiratory distress. I was surprised to learn that this child was Oliver. I found him in the Emergency Department, struggling for air in his worried mother’s arms. Cultures retrieved via lumbar puncture confirmed Klebsiella pneumonia: Oliver had meningitis. I watched attentively as the senior pediatricians met with Oliver’s anxious family to discuss his diagnosis. Throughout the careful explanation, Oliver’s parents asked countless questions, and these were each answered in turn. Oliver’s mother kept her most difficult question for the end of the discussion. She spoke with great hesitation and the words seemed to struggle to move past her lips:

“How will he do in the future, doctor?”

The pediatrician answered thoughtfully: “It is an unfortunate thing. We hope that everything will progress normally, but the reality is that…. no one can really predict how the inflammation around Oliver’s brain will affect his neurological development”.

“What does that mean?”

“We don’t know how he will do. I’m so sorry”.

Over the next several weeks, I was the family’s primary point of contact for the pediatrics team. Every day, I would round in the morning and check in on Oliver. I got to know the family very well. As the weeks passed, the team was hopeful as we noticed some clinical improvement. However, while Oliver appeared to be getting better, his family did not. Emotionally, they were deteriorating. The uncertainty surrounding Oliver’s prognosis tormented them relentlessly. They felt their own mortality as Oliver’s was threatened. How could they live in a world without their baby? With each passing day, they became less communicative and more withdrawn, silently hiding behind the wet streaks on their faces.

As I rounded on my patients one morning, I came across Oliver’s mother cradling her little boy. I immediately felt as if I intruded on an intimate moment between mother and son. I slowly turned around, signaling that I would soon return, but before I could leave the room Oliver’s mother said something I will never forget:

“Being positive is an odd thing, Jeremy. Do you ever notice it is easy to smile when nothing is wrong?” She chuckled and cried at the same time. “The world is easy when you can control it.” She began to sob. “How can I believe he will ever be better?”

I didn’t know what to say. The love that I saw in front of me was both inspiring and devastating. It was clear that Oliver’s mother was overwhelmed and exhausted. She hadn’t left Oliver’s side since his admission. She was dehydrated and fragile. I felt helpless. I had no words. I put a reassuring hand on her shoulder, paused, and surprised myself by saying the only thing that felt really genuine in that moment: ”You need some water.”

I returned several minutes later with a bottle of water and a stack of my unorganized medical school notes.

“What are those?” she inquired.

“This,” I replied, “is how you will know that Oliver is getting better.” I yanked out two pages from the stack and gave them to her.

“The development milestones” I said.

I described the developmental milestones and explained how achieving each milestone would be a way to keep track of Oliver’s progress. Although no one could predict how Oliver would fare in the future, clarifying the milestones seemed to alleviate her anxiety. I also gave them anticipatory guidance around audiological testing and educational assessments. Only later did I realize that by giving Oliver’s parents control over some aspect of his illness had provided a great deal of comfort. It was empowering for them to know that they could contribute to their son’s well-being. As the weight of helplessness was lifted off of Oliver’s parents, I felt that it had lifted off of me as well.

All medical students have formative experiences during their training that shape their future career path. For me, it was when I received an email from Oliver’s parents one year after I first delivered Oliver. The subject read: “The developmental milestones”. Included in the email was an update on Oliver’s progress. I opened the attachment. The picture before me was of a little boy with a huge smile on his face, accompanied by the words, “Oliver’s first steps, right on schedule!” Since then I have received many updates regarding his wonderful progress. Receiving these emails has been one of the most rewarding experiences of my medical career. The relationship I formed with Oliver’s family was the reason I wanted to become a family physician.

Oliver and his family brought me to an important realization during my training that I will always remember: a patient may not remember what you said or didn’t say, or what you did or didn’t do, but, they will always remember the way make you made them feel. And it is the amalgamation of a lifetime of feelings and experiences that form the narrative of who we are. Everyone’s story starts and ends the same way…. Someone is always pushing for their life.

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