Ca-ma-ro-nes,” Anthony said, with a trill of the tongue over the third syllable. Between his bald head, his steroid-swollen jowls, and his tiny gold pinkie ring—“bling from my Papi,” as he called it—the 4-year-old looked like Tony Soprano's long-lost son. My lack of ability to speak Spanish irked Anthony, especially after he tried to tell me about his favorite food, shrimp, using the Spanish word. I responded that I liked macaroni, too, and then Anthony proceeded to school me about the word “camarones.” “Cam-a-roni,” I said. “No,” he said, and his bling waved furiously through the air as he talked with his hands. “Ca-ma-ro-nes.” “Ca-ma-ro-nes,” I repeated, and he held an A-OK sign in the air. As he tried to impart a bit of Spanish on his incorrigible student, I saw a glimmer of old-man wisdom in his spunky eyes. By midway through my second year of residency, I had lost some of my own spunkiness when it came to practicing medicine. As I shuffled monthly from one intensive care unit to another, I started to intentionally distance myself from the patients. As a resident, the intensive care unit–based patient interactions often took on the form of a bad teenage relationship, the kind where I threw myself head over heels into passionate, intense love that burned out as quickly as it had arrived. After sharing such intimate initial moments with families, I found myself in, yet again, exhausting situations. I moved onto yet another rotation, the young patients died, or they were transferred to the step-down unit so quickly that I felt jilted and drained. Try as I might, I couldn't distance myself from Anthony. A week after I met Anthony, he celebrated his fifth birthday. His mother invited me for cake that afternoon. “My Papi is going to pick me up in his convertible,” Anthony said. “He's going to take me to the water park and then we are going to go out to dinner. I am going to get steak and camarones.” His mother winced. Afterward, she followed me out of the room. “His father isn't coming. He hasn't visited Anthony once since Anthony got sick 2 years ago,” she said. She reminded me that as mature as Anthony appeared, he was still a 5-year-old who had undergone brain surgery. “He clings to the hope that his father will visit. And I’ll have to clean up that mess tomorrow when he doesn’t.” The next morning during rounds, Anthony showed me a shiny new piece of bling on his other pinkie. “My Papi's convertible is broken. He sent me this ring for my birthday. And some new race cars,” Anthony said, pointing toward a stack of metallic toy replicas at the foot of his bed. His mother looked at me with plaintive eyes. “But my Mami and I still had the steak and camarones he sent.” “That's a beautiful ring, Anthony,” I said. “Can you show me how some of your new cars drive?” Anthony grabbed a slick, yellow Corvette and raced it across the length of his tray table. At the end of the month, I readied myself to make another transition to a new service. Anthony had several more days to go before we expected his cell counts to return. I had wondered how I should communicate my impending absence to Anthony, so I asked his mother what she would recommend. She told me not to worry, that she had tried to explain my temporary role as a resident. My final morning on service, I simply said goodbye to Anthony and told him I would visit him the next time he came to the hospital for chemotherapy. Three weeks later, I noticed Anthony's name on one of the inpatient bed lists. He’d been admitted several days earlier. I went to say hello. After I gowned and gloved and walked into his room, he glared at me from behind his pouty, chubby cheeks. “I thought you were my doctor. But you haven't come back to see me in the mornings,” he accused me, and I felt the sting of his sense of abandonment. “Anthony!” his mother interrupted. “No, no, it's okay,” I said, knowing that, in a way, I had deceived Anthony. But I also knew that, short of working on a service for months in a row, the fanciest of schedules could not have avoided this constraint of residency. I would have to actively seek out other ways to maintain meaningful connections with my patients, many of whom weren't really “my” patients anymore. I started by simply reminding both my patients and myself of my role as a resident. As I slowly learned how to manage the constant chafe between the frequent transitions and the formation of meaningful patient relationships, I grew out of my nihilistic, second-year-resident, teenage angst. This growth spurt began with Anthony. I asked Anthony how to say, “I want to be your friend in the hospital,” in Spanish. “Quiero ser tu amigo en el hospital,” Anthony responded. “Queero sehr tu amigo en hospital, little ca-ma-rón” I told him. “Okay, de camarones grandes.” Back to top Article Information Correspondence: Dr Feinstein, Department of General Academic Pediatrics, Children's Hospital Colorado, 13199 E Montview Blvd, Ste 300, Aurora, CO 80045 (email@example.com). Financial Disclosure: None reported.
Archives of Pediatrics & Adolescent Medicine
– American Medical Association
Published: Oct 3, 2011