Half As Sad: A Plea for Narrative Medicine in Pediatric Residency Training

During my third year of general pediatrics residency training, a patient well known to me and my fellow residents died unexpectedly. The child was an extremely bright and mature 8-year-old who had spent much of the last year of her life in our hospital being treated for cancer. Seemingly overnight, she became “too” sick (ICU sick, intubated and ventilated, on dialysis sick). She began to have intractable seizures, and with her family by her side, she died. The next morning, a colleague in his first year of residency asked how I was. I said that it had been a difficult week and I felt profoundly sad about the death of our patient. A look of relief came over his face. He told me that he was feeling despair. This was the first child he had cared for that had died. He had never felt such sadness before and felt guilty for feeling sad. He said that in medical school he had been told by a senior physician that it was the professional responsibility of a physician to “never feel more than 50% as sad as a patient’s family.” Faced with the reality of the death of a child, my colleague was left feeling confused, distressed, and disenfranchised from his own emotional response. “You put on the waterworks and it makes the parents feel better,” my genetics attending said. She seemed proud to have arrived at this simple remedy. She had just finished counseling a couple whose child had been diagnosed with a lethal genetic condition. Were the tears an act simulating empathy for … Address correspondence to Malgorzata Nowaczyk, MD, FRCPC, FCCMG, FACMG, Department of Pediatrics, McMaster Children’s Hospital, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada. E-mail: nowaczyk{at}hhsc.ca

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