Voice

There's a 3-year old kid on our pediatric hematology-oncology service who has a high-risk, stage IV, disseminated neuroblastoma: a bad cancer with a terrible prognosis. The mass in his liver is huge, and distends his abdomen way out of proportion to his limbs. He is otherwise a truly beautiful child, with big, blue eyes and an open, winning smile.

I went in last night at about 3 a.m. to examine him because he had spiked a fever. When I laid my hand flat on his belly, he opened his eyes and said, in full voice, "Don't hurt me!"

In my training, I do both adult and pediatric medicine. However, although I've been on pediatric rotations for months now, it's the nature of my program that I spend very little time actually talking to and examining my pediatric patients. It's possible that I know less about what kids are like now than I did before I started my intern year.

Perhaps that's why I was stunned to hear him tell me not to hurt him. Adults rarely use those words--they usually just cringe, or make a grim face, or sit quietly. Perhaps they've lost the sense that they have a right to be comfortable.

This is developmentally appropriate, on some level: understanding that some unpleasant things are good for you and must be tolerated is a part of maturity. I only hope that it is maturity and not a sense of powerlessness that causes so many adults to remain silent when they anticipate pain.

In my overnight call-addled state, it seems like a good idea to try to hear this boy's voice every time I go in to see a patient--perhaps especially when I return to adult medicine, which I do in two weeks.