My two greatest fears before starting my pediatric rotation were finding common ground with a critically ill child and looking incompetent. The second fear seemed easy enough to conquer if I studied the material prior to my clinical days. The first one, however, would be more difficult and out of my control. How would I care for a child that might not have long to live? What topics do I bring up in conversation? What if I slip up and make an inappropriate joke? These questions would prove to be a hinderance to my care of a patient who just wanted to be treated like everyone else.
My clinical partner Diana and I were tasked with taking the vitals of our patient, J.R., first thing in the morning. The 18-year-old, schedule 1A cardiac transplant patient we were assigned meant that this was not going to be an easy day. My approach was very professional as I used my penlight to find the patient’s blood pressure cuff and inspect the safety measures of the dimly lit room at 7:15 a.m. With my free hand hiding the beam of light from my sleeping patient’s eyes, I searched around the bed for a mere second before I heard a voice from above saying, “Are you looking for this?” As J.R. handed me the blood pressure cuff that was wrapped around the left side rail of his bed it was clear to me that my second fear had just become realized.
Unfortunately, my initial visits with J.R. did not help alleviate my second fear at all. This was a patient who had been in and out of the hospital for heart issues since the day he was born, rattling off medical terminology as if they were names of his favorite pop stars: pacemaker; hypoplastic left heart syndrome; and open-heart surgery. Clearly, I wasn’t going to outsmart J.R. using fancy textbook words and techniques. This became abundantly clear on the second day of my clinicals when I tried to show him my fancy nursing tool kit including reflex hammer, tuning forks, and scissors, only to be met with a bewildered look from J.R. and a question, “Where’s your gown?” J.R. had acquired C. Diff in between our meetings, and I cannot think of another way that I could have looked more incompetent than not donning my isolation precautions before entering the room.
What I was left with was my first fear, finding common ground with my patient. I asked J.R. about his hobbies and learned how cooking was one of his passions. He told me how he planned on attending culinary school once he was out of the hospital, returning to his hometown in Long Island, and opening a casual dining style Mexican restaurant. This felt like progress. Still, there was a sense of detachment in our conversation. Even though J.R. was divulging all this information about himself, he constantly looked towards the entrance of his room, watching everyone walk by as if he longed to be outside with them. It was then that I began thinking about the social aspect of J.R.’s day.
I decided to approach this teenager as I approached my own teenaged social interactions, with a group of friends joking around, teasing each other, and even mildly insulting our favorite television shows. I reasoned this because I imagined being in and out of the hospital ever since the day I was born, not being able to have a steady group of friends because I had a heart condition that had to be constantly monitored. The group of friends in this case would be my classmates, a handful of pop culture movie and food enthusiasts who would spark an engaging conversation. It was obvious from the start that I was the least knowledgeable about the latest Netflix series, and once again my ignorance was the focus of the experience as I was teased for seeming uncool. I may have even uttered the phrase, “They don’t make movies like they used to,” more than once. Although, being the butt of their jokes was the last thing on my mind when I noticed that J.R. was enjoying himself as part of the group and having a laugh at my expense. If my ignorance bonded my patient with my classmates, then it was to my benefit. The group could tease me all they wanted for sounding out of touch, but I could smile through it all because through my failures I had pulled from my resources to improve patient care. My team had done the job of finding common ground.
Maybe I don’t need to worry about playing it safe. Maybe this was part of patient care. The obstacle of overintellectualizing my approach had been removed and I gained a confidence in my ability to speak with this pediatric patient that I felt I could carry to future patients. Moreover, I look forward to the day I can visit J.R.’s casual dining Mexican restaurant, walk into the kitchen to see him cooking, give him a bewildered look and ask him, “Where’s your hairnet?”