By Susan Flynn
When she graduated from medical school, Meghan MacLean Weir acknowledges, she was officially a doctor. But, in her new book, Between Expectations: Lessons from a Pediatric Residency (Free Press, 2011; $25), she reveals that this transformation actually takes place later – with much tenderness and angst – on the floors of Children’s Hospital in Boston, where she routinely worked 30-hour days.
In her candid reflections, McLean Weir introduces us to the first patient she yelled at – a poor woman treated for a sexually transmitted disease whose boyfriend was in jail for hitting another woman. She describes a young couple who desperately wanted their premature baby to live but didn’t fully understand that the child was too disabled to have much of a life. And she writes poignantly about Max, the teen with leukemia whose death hit her particularly hard.
We spoke with MacLean Weir, who today is a pediatrician in the emergency departments at Children’s and Beverly hospitals.
1 Looking back at your internship, what was your hardest case?
Some of my most challenging patients were not necessarily the ones who were the most sick. I remember one set of parents whose child had a seizure during a fever. When I told them that the tests looked OK and they could go home, they actually got very angry. It was as if they wanted there to be something wrong, just to have an explanation for the seizure. The problem was that I didn't know enough then to answer their questions in a way they would find reassuring, so I had to ask for help from a supervisor who went back into the room and told them things were OK. The parents believed him, whereas they did not believe me. It made me realize that even giving good news can be complicated and difficult when families are scared.
2 What advice would you offer a new intern at Children’s?
Don’t be afraid to ask for help. I think this is an important lesson in medicine, as well as in life. In the hospital, making good decisions for a patient often means getting input from someone else. It took me a long time to believe that this was true, and it’s something I still struggle with.
3 What do parents do that upsets pediatricians most?
I think what’s most frustrating is the parent who puts words or emotions into a child that belittles a child. Any child is going to take their cues from a parent. Take a child with a laceration who needs stitches. The kid who won’t be overwhelmed is the one whose parent is calm and reassuring. I’ve had a handful of parents say, ‘He is a really nervous kid. He is going to need sedation.’ Usually, the parents who say that are balls of nervous energy themselves. I think expecting the best out of your child is what I hope for any parent.
4 What can pediatricians do a better job at?
I think what gets lost sometimes … is that we don’t take the time to say how much we appreciate parents and acknowledge how hard it is to take care of a sick child. I have never met a pediatrician who hasn’t been filled with awe at how strong and amazing families are and how much work goes into parenting.
5 How has becoming a parent changed you as a doctor?
There are many things that are easier, from nursing advice to commiserating on just how hard it is to get through the night with a child with a fever. Before my daughter was born, I always felt that there was some piece of these discussions that was disingenuous, because I didn’t know what it felt like to be on the other side. It also affects how deeply affected I am by cases where children get horribly sick. I have anxiety coming home in a way I never did before. But at the end of the day, I also get to feel incredibly lucky. I get to leave work behind and focus on my daughter.
Susan Flynn is associate editor at the Boston Parents Paper. She can be reached at email@example.com.