During my first night on call as an intern, I felt scared. Not just scared--terrified. I was serving on the medical center's pediatric oncology floor, and medical school hadn't prepared me for children with cancer. What did I know about cutting-edge chemotherapy regimens? What if a child suddenly developed an overwhelming infection or a seizure triggered by a tumor? Someone would expect me to know what to do.
"It's okay," said Brad, the second-year resident. "The nurses do everything. You just treat the kids' hypertension."
"How?" I asked.
"Hydralazine," he answered, glancing at his watch. He looked tired and ready to split. "Ten to twenty milligrams IV every four hours." When I looked up from my hasty scribbling, he was gone. I was alone.
For reassurance, I touched the small but reliable pediatric handbook in my white coat pocket. My other pocket was stuffed with index cards, each labeled with a patient's name, diagnosis and quantities of information written in my tiny print.
I looked down the hall towards the spill of light at the nursing station, the darkening corridors lined with rooms of sick children all trying to sleep--or at least not vomit from the chemotherapy.
I just wanted to go home. I thought about hiding out in the call room and pretending to sleep. I felt nauseated myself. Had I even eaten dinner?
One of the evening nurses emerged from her station. My heart quickened.
"Dr. Caplin," she said firmly, "we have a young patient who's expected to die tonight. You have to speak with the parents. His room is at the end of the hall. His name is Robert."
I found his index card: sixteen years old, three years of leukemia, transferred from somewhere in the Midwest. At checkout, nobody had mentioned anything to me about Robert's dying. How unfair! Wasn't this important enough to tell me? I felt at a loss, inadequate, let down by my supervisors--and by my useless index cards.
"I'm not sure what I'm supposed to do. What do I say to them?" The nurse studied me for a moment. "Just check in and see if they need anything." She hesitated, then added, "You can offer to bring them coffee."
I took a deep breath and headed down the hall. The lights of Houston twinkled through the end window; I wistfully imagined my cozy apartment, then knocked gently at the door and entered.
Robert lay in his hospital bed, peacefully unconscious thanks to the medications dripping through his IV. His mother and father sat in chairs on either side of him. Except for the lights from his heart monitor and the distant city, the room was dark. When his mother turned on the soft background lighting, I saw that Robert was strikingly handsome despite his baldness and pallor, looking more a man than a child. Somehow, from beneath the oxygen mask, IV tubing and monitoring wires, he conveyed a sense of deep inner strength.
I had expected his parents to be distraught. Instead, they seemed remarkably composed. I wondered how they were managing.
"Hello," I began. "I'm Dr. Caplin. I'm so sorry to hear about Robert." They both thanked me for coming. For some reason, they reminded me of the parents of a high-school friend. Suddenly I understood that they were normal people caught in a horrifyingly abnormal situation.
"Can I get you anything? Some coffee?" I asked.
"Oh yes, thank you, Doctor. That would be wonderful, actually," Robert's mother nodded, holding back tears.
Relieved at having something to do, I went to the nurses' station and poured the hospital-issue, slightly burnt coffee into two paper cups. When I returned, both parents jumped out of their chairs and busied themselves with sugar packets and coffee whitener. Seasoned medical parents, they seemed to know that I was a young resident.
They clearly welcomed my presence. They wanted to know where I was from; they wanted to talk. Robert was a terrific son, they said--their youngest, and so capable, with a quick mind and sense of humor. He'd helped them run the family farm.
They said that the pain they felt was unbearable, but they also felt resigned. They wanted Robert's suffering to be over. They planned to fly back to Iowa in the morning; we all knew what they meant by that.
When it came time for me to leave, they shook my hand, and Robert's father said, "We wish you the best of luck in your career, Dr. Caplin. We know you'll make a fine pediatrician." I felt surprised and grateful. Only years later would I fully appreciate the power of his words. I left, encouraging them to have the nurse page me if they needed me.
The nurse, for her part, told me that my work was done, and that she wouldn't disturb me for Robert's expected death.
My beeper went off at 6 a.m. Instead of reviewing the labs and charts of fifteen children, I hurried down the hall to Robert's room.
Sunlight poured in through the windows. The bed was stripped, and his parents were gone. I felt the shock of death's finality; I would never see this family again. In the empty room, not even a coffee cup remained.
What does remain, more than twenty-five years later, is the tremendous gift Robert's parents gave me that night: the knowledge that even in the face of death I could still be of help, and that my willingness to be present as a person could matter as much as any medical intervention. They gave me a deep belief in myself--that I really would become a good doctor. And they conferred it freely, unknowingly and with such grace.
I'll always be grateful, too, to the nurse who took a risk and suggested to a young doctor an unconventional yet potent treatment: the simple offer of a cup of coffee.
About the author:
Abby Caplin MD MA practices mind-body medicine and counseling in the San Francisco Bay Area, placing the healing relationship at the center of her work with patients. She specializes in treating women with autoimmune disorders and holds workshops entitled "Finding Meaning in Medicine" for residents-in-training (www.abbycaplinmd.com).
Jo Marie Reilly