A student writes about an extracurricular activity

During first year and the summer after first year, I worked in the Childhood Obesity Clinic.  It was a fitness clinic and nutrition clinic for overweight kids in the community.  When they came, the kids would receive education and also a chance to exercise in an effort to combat their obesity and the self-esteem and other social issues that came with it.  The nutrition component was very interesting.  You would see the kids knowing the correct answers to all of the questions we asked: how many calories are in this, how much fat is in this, is fat better than carbs, are carbs better than protein, which vitamins are in this food, etc.  However, it really seemed like a game to them.  They would go to McDonald’s on the way to the game, then play the game and answer all of our nutrition questions, and then leave and go back to McDonald’s on the way home.  It taught me that it is not enough to give patients information and then challenge them to learn it and to answer questions correctly.  If you expect to help people change their unhealthy habits, you have to make sure they really hear what you are saying, understand the significance, and buy into the idea.

In addition to this valuable lesson, I also learned tremendously powerful lessons by playing games with the children after the nutrition sessions.  One day, we played football with two mixed teams of medical students and clinic participants.  There were several very bright, very motivated medical students who wanted to help these kids and several very, very overweight children.  Watching the game, you could see that these kids had never had a chance to really interact in a physical way with their peers.  It seemed that they wanted the opportunity but had not figured out how to obtain it yet. 

I remember very vividly one particular play in which I threw a touchdown pass to one of the little boys.  He was a 12-year old kid who was probably about 4′ 5″ and extremely obese, and it was remarkable to watch his eyes light up as he caught the ball, turned, and ran down the field with medical students following after him.  They were not necessarily trying to outrun him, but they gave him the chance to compete as he ran all the way down the field.  When he scored the touchdown, he did a little victory dance and really celebrated.  It was wonderful to see how much he benefited from what he was able to do and feel.  The physical experience during our games was probably more valuable to these kids than any of the nutrition instruction.  I am happy to say that I think my classmates and I have continued to remember this lesson, especially during our clinical years.  There is much more interacting than lecturing when we are learning from each other, and this is also true in our patient relationships.  I think it’s really a wonderful thing to see.

A pediatrician writes about a remarkable resident and family-centered care

The KCRC prides itself on providing family-centered care from the housekeepers to the pediatric attendings. Families participate in all the interdisciplinary team meetings and share in making clinical decisions. Families serve on the KCRC Advisory Board and search committees. And the KCRC values each patient and his or her ability to make functional and developmental progress at their own rate. Insurance payment for inpatient head injury rehabilitation is based completely on the established metrics of cognitive and physical recovery from trauma or disease. The KCRC staff champion all the children, infant to adolescent, especially the most disabled. Well, usually, that is….

This six-month old baby, a former 28-week premie, was making no progress and had made no changes since she had been transferred from the NICU three months earlier. Not even a reflexive suck or doll’s eye opening. No change in her vital signs. Not even diurnal variation in her body temperature which remained rock solid at 94 degrees even with swaddling. No response to cuddling in the rocking chair or lullabies from the nurses. One of the parents called the nurses’ station regularly every afternoon to inquire about her progress, but they had long stopped visiting. There were no wrist rattles or pretty pink onesies hanging on her crib.

The family wasn’t ready to take her home with their other three healthy children and they weren’t agreeable to her transfer to a nursing home. The doctors, the nurses, the social workers, the finance officers, the Clinical Ethics Team, their family doc and the local public health nurse had all tried unsuccessfully to reason with the family. The lullabies gradually stopped, the pediatric team skipped that crib on morning rounds and the chart notes became more about the responsibilities of the institution than the rights of the patient. A Medicaid nursing home bed was identified in Richmond and transportation for a safe transfer was arranged with one of the KCRC nurses in company. A final summit with the family was planned on a Saturday morning……who on the team had the best rapport or the most power? Who would sit in the family lounge over coffee and deliver the absolutely final eviction notice? There were no volunteers.

I was the inpatient attending outlining the tasks for the weekend, including the parent conference scheduled on Saturday morning. I had assumed that I would end up doing the dreaded duty. But no, my intern, Dr. H., suggested that she thought she would like to try…she had answered the phone yesterday at the nurses’ station when the mother called in and she had given the 24-hour update to the mother. It felt like a connection to Dr. H. I acquiesced but felt a little guilty in doing so, And so it was that I dawdled in the house staff office, waiting to be called for the inevitable rescue of my first-year resident. And here she was at my elbow…

“We need a priest….right now,” she said to me.

“What for….? I can probably get the hospital chaplain on call to come in,” I replied, more than a little nonplused by the urgency of the conversation and the unexpected call for clergy on a Saturday morning.

“No, no!” she insisted. “We need an honest-to-God Catholic priest…right now, before they change their minds.”

“Okay, okay, but what’s happening about the transfer? Shall I call the ambulance service?” I pressed. “What’s going on in there? Shall I come in with you?”

She shook her head and rushed to say: “No, no.” Her words erupted: “I introduced myself and sat down. And right away …when I asked about the baby’s first name… you know how you’re always supposed to call the baby by her name when you deliver bad news? I think you taught me that even… the mother started sobbing and I got her a Kleenex, you know, I had the box right next to me just like I was supposed to….well, I put my arm around the mother’s shoulders and patted away and she just kept sobbing…then the father explained that their baby didn’t have a name, probably not even a soul …because she had been too sick in the NICU to be baptized, and then the chaplain was a Unitarian and now she would end up in limbo if she went out in the winter air to get to the ambulance… and then out on the highway to Richmond there might be an accident ….she’s so little and the traffic is so fast on route 64.” She took a quick breath and kept going. ” SO, I need a Catholic priest right now… and the baby’s name will be Mary Beth, and then the baptized baby Mary Beth can go live at the nursing home in Richmond… then, if anything happens to her, she will go straight, absolutely straight without questions asked, to heaven… and then, the parents can go back to church again, to Saturday night confession again and take communion at Sunday mass with all their neighbors…. It’s okay, honest, we just need a Catholic priest right now.”

And so I called St. Thomas right around the corner from the KCRC. We had a priest in no time. No one seemed too concerned that his Saturday morning attire featured sandals, jeans and a clerical collar under a sweat shirt. Dr. H. and the nurse stood in as godmothers. The baby was duly baptized “Mary Beth in the name of the Father and the Son and the Holy Ghost. ”

The Pediatric faculty and residents at Monday’s morning report were stunned when Dr. H. reported the successful transfer of Mary Beth, the hugs from these most difficult parents and the general disbelief of the KCRC staff. Dr. H. was recognized at the formal Rotunda dinner the following June as the most family-centered resident in Pediatrics. And the staff and faculty at the KCRC reflected once again that family-centered care is redefined by each family and not by the staff.. Isn’t it grand to have all those idealistic students and residents around to teach when we wise ones lose our way?