I am lucky to witness the bravery of children every single day while I am at work.
I was working my Thursday evening clinic, hustling to see my patients in a timely manner. The afternoon and evening passed by rather uneventfully. Many well child care examinations and a sprinkle of otitis media, strep pharyngitis, chronic cough, molluscum contagiosum rash and atopic dermatitis. Pretty basic pediatric fare, which my fellow colleagues and I could treat on autopilot.
One of my last appointments for the night was weight loss. I eyed the complaint on my schedule with a slight grimace. Weight loss could be anything from eating disorder to celiac disease to inflammatory bowel disease to hyperthyroidism to liver or kidney dysfunction to new onset diabetes. The diagnostic possibilities abound. My pre-teen patient greeted me with a sweet outgoing smile. We discussed the stability of her chronic heart condition as well as her 8 pound weight loss over the past 2 months. For a lithe girl, eight pounds was twelve percent of her body weight. Her family had reassured me that she had been eating in a much more healthy manner over the past 3 months, exhibiting an increased appetite at meals and cutting down on sweets and junk food. When I questioned them about urinary frequency, they mentioned increased trips to the bathroom the previous week, which seemed to resolve by the beginning of this week and denied increased thirst. I advised some very simple tests: a urine dipstick and a fingerstick to check blood glucose. Unfortunately, the diagnosis was made quickly. My patient was spilling significant glucose in her urine and had a one hour postprandial blood sugar in the 400s. Luckily, she had only trace ketonuria and was not in diabetic ketoacidosis.
Even after years of relaying bad news to patients and their parents, I will never shrug off the sting of a negative diagnosis. I told my patient and her family directly and simply, “You have new onset diabetes. We need to admit you to the hospital for further testing and education.” I will never forget the crumpling of her carefree, innocent, happy face. She was a bright girl and understood that the diagnosis of diabetes was not inconsequential. She immediately understood that there would be changes in her young life. She whispered softly, “It is just not fair.” A pristine tear rolled indolently down her smooth cheek. In that moment, my heart splintered a little bit too. She had already learned to live with a chronic heart condition and now added diabetes to her medical problem list.
Fortunately, her protective tiger mom and grandmother swooped in to envelope her in a tight, loving embrace. They rubbed her frail back while tears were streaming down their own anxious faces. I briefly discussed my plan for the night with the family and asked if they had any immediate questions. I then stepped out of the exam room to work on admitting her to the hospital. During this time, I could hear deep sobbing coming from the exam room, likely from all three generations of this strong family.
When I returned to the exam room, I crouched down on the floor next to my sweet patient and gently lifted her trembling chin. I told her, “You are so strong and so brave. I have seen you overcome many tough things. This does not change who you are as a person. You are beautiful and smart and funny. You have an incredible future ahead of you. You will live a good life. We need to get you to the hospital to give you all the tools to continue to live a good and happy life.” And my brave sweet patient nodded and I witnessed in her eyes a strength that she pulled from deep within. Her sobbing abated and her trembling stilled. She was like a courageous warrior going into battle. She returned my hug firmly. When she walked out of my clinic that evening on her way to the hospital, her narrow shoulders were straight and her back was erect. Her valor and spirit were up lifting.
All my lionhearted plucky patients battling cancers and chronic diseases are truly my heroes. They exhibit such mettle and moxie and set such staggering examples for their peers and adults alike. They learn to persevere and do it with such grace and optimism. Due to my profession, I learn so much from my young patients’ every day and admire their fortitude and that of their stalwart families.