From pediatrics to psychiatry: A physician's journey

I loved working as a pediatrician. The children, with their vitality and energy, brightened my workday. Parents were often concerned and anxious. I enjoyed being able to put the parents at ease by sharing information about their child’s illness and helping them feel in control again. But it was when things went differently that I did not always feel at ease. It was on hard days, when a child was newly diagnosed with a serious condition or gravely ill, and the parent is bravely bearing the pain, that I felt ill prepared to address the emotional chaos that the family was entering. Visiting the room in rounds, I would cling on to the concrete facts to help me navigate the interaction without losing myself in the emotional pain: discharge dates, instructions to follow, follow-ups, prescriptions. 
 
As a hospitalist, I often felt upon leaving the room that the biggest issues for that family may not necessarily be the new diagnosis, or the medications nor the next appointments. I felt that the bigger issues centered around the emotional ripples that the new diagnosis, prognosis or illness caused. The issues they had stoically not talked about, and that I had not dared dive into. How were they dealing with the diagnosis? How will they cope with the life changes that this illness will bring to the family?  How are the siblings understanding this? Is the three-year-old sibling afraid this will happen to him, too? Does the seven-year-old sibling feel this is her fault? Is this causing marital problems? Will my patient grow up feeling different?  How will this patient transition back to school? 

And at times that I took care of a child who died. I wanted to support the family through unbearable, unimaginable pain. Where could one even start? It has been 20 years since I experienced the first loss of a patient, as a medical student. I still think of her. I think of her sister, who was almost daily in the hospital, and wonder how she is. I think of the mom, who was there that night. My heart still aches, two decades later.
 
I feared that addressing these questions could crumble them -and could crumble me as I was unprepared to enter this role. Many days I found myself wondering if indeed, to be able to do this job, I had to keep certain emotional distance as I had been advised to do so many times. But human nature and our vocation as physicians draw us the opposite way: to be with the patient, to understand their pain, to help ease their pain. And there it was, that fine line between burnout and emotional closeness; between seeming compassionate and distant; between feeling human and diving into somebody’s pain while allowing yourself to stay strong to see your other patients that day. This is the daily struggle that doctors face. And that was the line that in becoming a psychiatrist I hoped I would learn to navigate better.
 
And I have. I have learned to hold my patient’s pain without fearing that they (or I) would crumble, like I once did. I no longer feel the urge to fill the space with facts; I have learned to remain curious and to stay silent. Most days, I can navigate these rough seas with my patients and their families and feel certain that I will help them find a shore. It might take a while; it is a process. That, I have learned to embrace as well.