Thursday, August 26, 2010

Carpe Diem

In pediatrics there is a syndrome called the “vulnerable child.” This occurs when a child has a severe illness, such as prematurity, a severe accident, a severe event. Parents are scared out of their wits, and when the child recovers they wonder,, is he OK? Was damage done that isn’t apparent? Supernaturally, is there some fatality at work that will emerge later, a tainted future?

When I was just starting in practice I covered for a colleague on his day off. I saw a teenage boy, big and strapping, six feet tall and muscled, probably played on his football team. I examined him and told his worried mother, “He looks OK. Nothing serious.”

She said, “Are you sure?” Pause. “Doctor, he was a premie, you know.”

Luckily, I knew about Vulnerable Child Syndrome. I had to laugh, and told her that her fears were understandable, because she had been through a trauma that left her considering her football player as somehow vulnerable. I said, “But look at him! Don’t worry.”

In our house we have our own vulnerable child. Peter had his birthday yesterday. The little tyke is now 27 and a third year law student. He was a premie himself, 35 weeks, five pounds seven ounces, while his mother had HELPP Syndrome, which was then a month or two short of being described in the literature, which left us to fend for ourselves in diagnosis. She presented with a nose-bleed that wouldn’t stop because her blood was coagulating within her veins. Luckily she went into labor and had Peter – in those days a trained nurse or technician didn’t attend every delivery, and it was left to me as the father to resuscitate Peter, which I did, but he was in the hospital for over a week, I guess, looked like a drowned rat, and Ann had a bone marrow aspiration and clotting tests for days in the ICU as she recovered, which she did, since pregnancy is the cause of HELPP.

Then at age two Pete needed heart surgery to close a hole, called an ASD. But not before the insurance company tried to revoke our policy, on the grounds that we failed to reveal when we got the policy that Pete might need surgery, which of course we didn’t know. This insurance company practice, called rescission, was just outlawed by ACA (Obamacare). That operation went well. He was up and in the halls saying “Pitch to me!” just a few days later, amazingly, on the same floor that I had done my residency on.

Then at the beginning of his junior year of high school Pete was on a camping trip to foster class solidarity. In the middle of the night a 4,500 pound tree fell in the midst of the sleeping group and Pete was only saved because, to the amusement and derision of his classmates, he had brought a very puffy air mattress along with him – he apparently shares his mother’s and father’s attitude to roughing it. The tree fell right on him, but the air mattress cushioned the blow enough that he escaped with losing a kidney, 18 inches of small bowel, five broken transverse processes of his lumbar spine, a broken wrist, and no trauma to the spinal cord. It was weeks and months of recovery, and the scars of the heart surgery and the tree trauma now form an anterior zipper line from neck to pelvis, almost. You can imagine the trauma his parents endured as well, with the 4:30 AM phone call of your son is in critical condition, and the days afterward.

Pete now has a truly existential view of life. He knows that we all die, and that we could do so at any moment. He is not afraid, but carpe diem is definitely for Peter.

And so it was that we received word yesterday of how Peter celebrated his birthday. Peter went sky diving from 18,000 feet and loved it.

He told his parents afterward. That was thoughtful of him.

Budd Shenkin

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