My Unforgettable Patient

A few months ago, my eight-month-old daughter lost her balance, teetered and fell face first on to the livingroom carpet. She bit her lip. It bled.

Have you noticed already - the carpet, the fall from her own height? These are cues that she was fine. If a medical student or resident had presented the same story to me in the children's ER where I am a fellow, I would have smiled and asked: "First-time mom?"

In pediatric emergency medicine, first-time moms achieve a certain level of notoriety for coming to the ER over benign issues: colic, constipation, spit-up. Whether this notoriety is deserved can be debated. But what is certain is that being a first-time mom myself, the first thing I did was scoop the child into my arms and race to the nearest emergency room.

Was my reaction so crazy? The holy grail of pediatrics - and of motherhood - is a healthy baby. In fact, my vigilant protection of our daughter began the day I learned I was pregnant. I took folate, renounced martinis and avoided mercury-laden fish. If somebody on the sidewalk was smoking a cigarette, I crossed the street. When my baby was born perfect and whole, I breathed a sigh of relief. But now she was bleeding. Injured! I could hardly keep myself from pushing past all the ER patients, through triage and into a sick bay.

A resident came out to the waiting room to take a look at her. "Did you wash your hands?" I asked her. "It's RSV season." (RSV is a common respiratory virus in small children.) She blinked at me. "Are you a doctor?"

I was quickly brought back into the ER - not into a sick bay, but into a non-acute bed. Since my daughter was playful, eating the white paper off the stretcher and trying to crawl around on the floor, I decided this was probably OK. Actually, I began to feel embarrassed that we had come to the ER at all. Was I one of those notorious first-time moms?

A fellow exactly the same year as me examined my daughter. Actually, we know each other well. Pediatric emergency medicine is a small world, especially in New York City, where all five fellowship programs are crammed onto an island 13 miles long. "Wow," she said."You had your baby!" I felt my embarrassment turn to relief as she explored the tiny mouth, my daughter's two little bottom teeth. She felt her clavicles, her belly. My daughter giggled.

Next the attending came to see us. "I have two kids,"she said. "I know exactly how you feel."Infinitely relieved, I took my daughter home.

A few hours later, on my overnight shift, the first patient I saw had also fallen down. She had a big hematoma on her forehead, but otherwise, she was completely fine. In fact, most of the patients that night were fine. They had coughs and colds, minor bang-ups and stomach bugs. Their parents were all nervous, tired, upset. "I know exactly how you feel," I said, more times than I'd ever said it before. I had found those words to be powerful, practically medicinal.

In an early photograph, I am standing next to my husband, holding our baby. She is jumping out of the picture. She is reaching for something, her eyes enormous, her face full of hilarity and zeal. All the possibilities of her life, all of her potential, are there on the page. They are dazzling. In the same photograph, my husband and I look happy but preoccupied. We are probably worried that she is hungry, wet or not dressed warmly enough. I can only imagine what shape these worries will take as she starts to run around, ride bikes, cross streets and even, eventually, leave home.

I'll never second-guess a first-time mom again, no matter what brings her to me in the middle of the night. Parenthood is an awesome state of wonder and fear. Anyone who says otherwise has never watched their toddler lose her balance, and, following her tumbling trajectory in slow motion, prayed that she'd land on her two tiny feet. TM

The author is a fellow in pediatric emergency medicine at Bellevue Hospital Center/NYU School of Medicine in New York City. One of her essays, "The Care of Strangers," was included in The Real Life of a Pediatrician (Kaplan), published this past spring.