I was lucky to do my pediatric residency training in Brooklyn. I connected seamlessly with the city and its people as if I lived there all my life. One evening in the hot summer of 2009, I counted hours on my last shift as a pediatric resident in the emergency room. I sat on a desk reflecting on my residency training, which I enjoyed very much, not because the work-life balance was outstanding. My residency training was similar to others, harsh filled with many long hours of hard work. Working in the emergency room often felt repetitive identical to the production line doing the same mindless tasks. Here is another toddler with a common cold, another prescription for Motrin, or another adolescent with constipation coming to the hospital in the evening because there is nothing better to do! However, not every day felt that dull. However, there were many times when I had a big “duh” moment. When I was able to understand people, medicine, and myself better. Moments like these are what made the residency program enjoyable. I didn’t know that I was about to get another huge “duh” moment on my last shift. I received a call from a busy community pediatrician. In her sweet voice on the phone, she told me that she referred a 20 months old girl to our emergency room. The poor girl saw the pediatrician a few days ago due to fever and was given an antibiotic medication. Now she developed a rash, which is probably an allergic reaction to the antibiotic. The pediatrician requested that I see the patient, reassure her family, and give Benadryl a prescription and change the antibiotics to something else that may be the child is not allergic to. I could not hide my boredom: “Yes madam, will do.” Here comes the girl with her parents. Like almost all of this pediatrician’s patients, the family belonged to the Orthodox Jewish community. After a few minutes conversing with the parents, I confirmed the pediatrician’s story of fever, some common cold symptoms, and now this rash pointing to their daughter’s chest and arms. I got goosebumps looking at the rash. I still get the same feeling thinking of it now. Not because the rash looked particularly scary or the child looked in distress. She looked cute in a sickly way, shy in her loving mother’s arms. I got goosebumps because I was hit by a thunder flashback that made me travel in space and time—thousands of miles from Brooklyn to my father’s pediatrics office in Cairo, Egypt, 15 years ago. I was in high school, shadowing my father in his clinic to decide if I want to pursue medical education. I was not very enthusiastic about being a doctor. I saw my father working hard as a solo practice pediatrician. I almost hated medicine because it took him away from us, his family, but I also observed his impact on the local community and how his patients loved and respected him. I could now mentally see myself standing behind my father. He was a tall, broad-shouldered man, examining a girl with the same rash. The rash was identical, but it was not the only common thing between memory and reality. The girls’ parents also looked very similar. Both mothers wearing decent long sleeves dresses s and head covers, holding the girls in their laps. The fathers with full non-trimmed beards holding small prayer handbooks. “Your daughter has measles,” my father and I said at the same time as my visual memory intersected with the current moment. I went outside the exam room to discuss the case with my attending, who said she has never seen a measles case before. “I had a distant experience,” I nodded my head quietly. I called the child’s pediatrician, who also never saw a measles case before, but she accessed the girl record and confirmed that she missed the recommended measles vaccine. I notified the Department of Health to report the case and was instructed on necessary confirmatory blood testing. After obtaining the blood test, we sent the family home with anticipatory guidance. A few days later, I made it to Texas to start fellowship training. Somehow, I felt anxious and homesick, which got worse as I learned that Michael Jackson died! Lost in the local Walmart huge aisles, my cell phone dinged. It is an email from one of my residency classmates, who is now the chief resident. He wanted me to know that I diagnosed the index case of a measles outbreak in Brooklyn. This patient story still feels like yesterday, very vivid in my memories. I have shared it with many during hospital rounds. I have shared it more this year than I ever did, probably for several reasons. Maybe because I want to confirm to myself and inform others how extraordinary diagnostician I am. Nah, pure luck made me in the right place and time in what felt to be two parallel yet intersecting universes. We all get placed in these experiences, and we need to watch for our “duh” moments carefully. Maybe as a reminder of the importance of fathers, good role models, and serving leaders in our lives. Even if we disagree entirely with their personal values, we should try to continue from where they ended. Learn from their mistakes and be inspired by their strength. Maybe because this is one of my first experiences as a young physician to understand social determinants of health, realize that humans have more in common than they can ever imagine, and comprehend that disease has no geopolitical boundaries. Maybe as I got my COVID-19 vaccine yesterday, while anti-vaccine propaganda conveniently forgets how many dangerous communicable diseases got eliminated by science in the twentieth century. 2020 has been a challenging year, to say the least, for health care and society, with the strains of the pandemic, social disparity, political polarization, and attempts of demonizing science. We all should reflect on our own past “duh” moments, take responsibility for our choices in the present, and hope for a better tomorrow. Michel Mikhael is a neonatologist. Source
