The Weight We Carry and why it’s ok that We’re Angry

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Progressive neurologic decline. Gastrointestinal failure. Quadriplegia. Trach-dependence. Global developmental delay. Intractable seizures. Near drowning. Hypoxic ischemic encephalopathy. Genetic mutation. Extreme prematurity. Congenital anatomic abnormalities. Meningitis. Death.

I just spent a week working in the hospital caring for sick and injured children (as I have since I started residency in 2006). And then I went out to dinner with another pediatrician and some non-medical people. The two of us pediatricians got caught up talking about our week at work, sharing heart-breaking stories (and also some gross stories that most would not appreciate during cocktail hour), reminiscing about shared patients from years ago (one of whom I learned had died in the interim), and laughing about things non-medical people might not think are funny.

Once we realized we had commandeered the conversation in a way that wasn’t exactly inclusive, we said something like “so sorry, we don’t have to talk about this stuff tonight.” And then a kind-hearted non-pediatrician said “it's ok, you need to be able to talk about this stuff.” That relatively simple gesture really struck me. We do need to be able to talk about this stuff, about the weight we carry from spending our days caring for sick and injured children. Children whose lives will be cut short. Children who will never learn to walk. Children who will never be able to feed themselves. Children who could walk and talk but then tragedy took it all away. Children who are waiting to die.

And on a more basic level, children who are hungry. Children whose schools are crumbling. Children who spend the night alone in the hospital because their parents are working multiple jobs just to make ends meet. Children whose parents can’t afford their asthma inhalers.

We stoically walk from exam room to exam room or hospital room to hospital room doing our best to care for these children and families and then we leave work and carry it all with us. After 15+ years of this, the weight of it all is almost unbearable (so unbearable that it drove me to run for Congress, against the uniquely horrific Nancy Mace). The suffering. The injustice. The compassion. The sadness. The joy. Some of you may know a child with a chronic illness, a child with cancer, a child who got really sick once and was in the ICU, a child who had a tragic accident. If you do, that individual child’s story probably changed you. You carry it with you.

Now imagine that x 10,000. That’s what your average pediatrician walks around this Earth with. It’s heavy. It’s profoundly sad. It changes you. It alters your perspective. I was at my 10 year old son’s recreation league basketball game the other day. We were getting whooped. One of the dads in the stands was growing visibly frustrated. I sat there and thought, “imagine thinking this matters.” I don’t even remember who I was before I carried the stories of my patients through this life. And even though it would be easier, I never want to go back to the person I was before. I don’t want to be a person who thinks a basketball score is a reason to get angry. Because as hard as it is, it is a privilege to share space with sick and injured children and their families.

Which brings me to my point, finally. (Thanks for going on this journey with me.) I am not angry about the basketball score, but I am angry. And I know that comes through in my writing, in my videos, in my tweets, and in my cocktail hour conversation. If I had a dollar for every time I have said something like “sorry, I just got on my soapbox there” over the past few years after gesticulating wildly to convey the multiple urgent crises our children face, I would have many dollars. I am angry because kids die everyday of preventable illnesses and injuries. I am angry because so many kids are uninsured or underinsured. I am angry because our kids’ planet is burning. I am angry because twelve-year-olds are being forced to carry their rapists’ babies. I am angry because insurance companies have the audacity to deny coverage for hospital days for kids who are ACTIVELY DYING but maybe didn’t die fast enough to maximize their profits. I am angry because rich people want to close down the only schools poor kids have access to. I am angry because those same rich people don’t care if kids go to bed hungry but definitely care if the Ten Commandments are hanging on their classroom wall.

I won’t hide that I am angry and I won’t apologize for being angry. But I also won’t let my anger get the best of me. I will continue to use it to fight for our kids. And I will continue to allow myself to decompress by sharing my stories with my fellow pediatricians who get it. Thank you to all of the non-pediatricians who kindly allow us to do this on occasion. I won’t let my anger steal my joy or turn me into a cynic but I will let it drive me to do things I never thought I was capable of doing (like starting our nation's FIRST AND ONLY Political Action Committee for kids). I hope some of you follow my lead. Take stock of your anger and then use it.

And I encourage the rest of you to try to understand that if pediatricians say there is a reason to be angry, there is probably a very legitimate reason to be angry.