I have worked as a paediatrician for nearly 30 years and yet I never cease to be struck by the immense privilege our profession bestows on us to be a part of people’s lives at some of the most difficult and stressful times. When I look at the families I work with now and think back to the many children and parents I have known over the years, my memory is just flooded with incredible and truly inspiring moments.
I was very clear that I never wanted to do Paediatrics when I left medical school! I thought that I had found my niche in Obstetrics and Gynaecology and was certain that this was the specialty for me. I loved the drama of the Labour Ward and I found the medical complications of pregnancy extremely interesting and intellectually challenging. Paediatrics, on the other hand, in my naïve eyes, was a really difficult specialty – your patients don’t lie still to be examined and there is the additional challenge of the three-way relationship of doctor-patient-parent. Little did I know that this is exactly what makes Paediatrics the wonderfully rewarding specialty it is!
So many families have made an impact on me over the years, and I wish I could go back to thank them for the role they played in shaping the kind of doctor I became...
I eventually stumbled upon Paediatrics after failing to enjoy either O&G or Adult Medicine, once I’d sampled them both properly at senior house officer level. My first junior doctor post in Paediatrics was in a very busy south east London district general hospital and I loved it from the moment I started. The variety, the teamwork, the huge range of ages and stages one deals with was a total revelation, and I have never looked back.
I eventually chose Neonatology as my sub-specialty interest – although I could have happily been a general paediatrician. Initially I was drawn to the drama and need for excellent technical skills in Neonatology. As time wore on, though, it was the depth of relationships one forms with families that I came to treasure the most, and this has stayed with me ever since.
So many families have made an impact on me over the years, and I wish I could go back to many of them to thank them for the role they played in shaping the kind of doctor I became and how much they have influenced me personally. It’s difficult to single out one patient in particular, but one child does spring to mind.
Charlie* was the third child in his family. Both his parents were journalists and they had two other healthy children aged four and two. The pregnancy was initially unremarkable but at the 20-week ultrasound scan Charlie was found to have a heart rhythm abnormality. This meant that Charlie’s mum had to have many antenatal scans during her pregnancy which sadly showed that not only was Charlie having problems maintaining a healthy circulation around his body, he had signs of brain injury too. Eventually, Charlie was born prematurely and admitted to the neonatal intensive care unit. He was very ill and needed a lot of support for his breathing and circulation. His brain scan showed widespread and devastating brain injury.
This isn’t about us – if it was, we’d want you to continue to do everything you can to keep Charlie alive. But that just isn’t fair on the rest of our family. We know we have to let him go.
I was the consultant looking after Charlie and I remember so clearly the discussions I had with Charlie’s parents. They were plain speaking people and they wanted the truth. If they felt I wasn’t using language that helped them truly understand the severity of Charlie’s condition – and his future – they told me. We went over and over the details as they asked searching questions, seeking to understand his chances of survival and potential future quality of life. Then they asked to be left alone to think.
A couple of hours later Charlie’s parents wanted to speak to me. He was only 48-hours old at this stage and I imagined they wanted to go through the details again. They didn’t. They had made a decision. They wanted us to stop all heroic efforts to keep Charlie alive. They wanted their other children to be allowed to join them and to spend some time together as a family. I so clearly remember the father saying, “We have to consider our other children’s futures. This isn’t about us – if it was, we’d want you to continue to do everything you can to keep Charlie alive. But that just isn’t fair on the rest of our family. We know we have to let him go.”
And so, they spent some time together. The grandparents joined them and the hospital chaplain baptised Charlie with everyone present. And then Charlie died.
I have never forgotten Charlie and his family. The pain etched on his parents’ faces will stay with me forever. The courage and clarity of thought they showed was extraordinary and the whole neonatal team learnt a lot about human good that day. I felt privileged to play a small role in their lives for that brief time.
Dr Camilla Kingdon is a consultant neonatologist at the Evelina London Children’s Hospital. She is also President of the Royal College of Paediatrics and Child Health.
- *. Names and other information that could identify someone have been changed.