Physician as Human

Sarah J. Palmer, MD

Tra I n I ng I n C h I l D an D a DO les C ent psychiatry has long been my goal. When it came time to construct match lists, I scrutinized curricula seeking out only programs that allowed me as much contact as possible with young people, developing personalities, the most vulnerable of our society. I had an aspirational, optimistic streak that imagined the future psychiatrist I would become. I imagined someone strong and capable, connected and sensitive, and that somehow my trajectory through fellowship would not only be one of growth but one of exponential growth in my ability to treat patients and provide relief to families.

Nothing prepared me for how training would unfold. Personal calamity, without exaggeration, landed me at 33 weeks pregnant in the Memorial ICU with sepsis due to pneumonia. It was mere months into my long-awaited entrance to child & adolescent fellowship training. I fought hard to be discharged, carefully stating my case using my degree to argue that I would know the warning signs to come back. My nurses tried to warn me: What I had been through, they said, was much more than I was acknowledging. One was even so frank as to say to me, plainly, “People come to the ICU and they die.” Apparently, I wasn’t hearing it.

I was placed on medical leave for months. The forced stillness of my body, fighting to breathe every day, sent my mind to anxious wanderings. I dared to google morbidity rates for sepsis in third trimester women. I tried to process what had happened but barely had time before my son was born. I fought to enjoy maternity leave but felt so vulnerable, so frightened, and the looming return to work was inescapable.

There’s a feature in the video game Mario Kart where, if you fall off the Rainbow Road, your character dies — but then a little angel picks it up and drops it right back where it had fallen. I had always wondered what happened at the depths of that fall, what happened to the character whose “life” was lost. This may be the anxiety that kept me from ever really enjoying video games, but this is also how I understand my return to work. The person I was before just... died... and now it is back to the races. A new version of who I am is here, rolling down Rainbow Road.

I am here, continuing on my path through child and adolescent psychiatry fellowship training in a national crisis that challenges even the most stalwart of my supervisors. As I reflect on my aspirations to become a child psychiatrist, I often feel far from being able to provide relief to families. Instead, I find myself partnering with them even more as we lament our dwindling resources, and the COVID-19 pandemic continues to take its worst out on the most vulnerable. Children suffer. I wish there were an aspirational path of exponential growth, and if it existed, I wish I were on it. At this point in training, however, I am realizing how human we all are. This work requires that we not only appreciate the humanity in our patients, but also the humanity in each other and the vulnerability that comes with that territory. +

Sarah J. Palmer, MD is a First Year Child & Adolescent Psychiatry Fellow at UMASS Chan Medical School. Email: sarahpalmer@umassmemorial.org