Tyrek's mother and I must have spoken for two hours in the Pediatric Intensive Care Unit, covering every topic but the one that was glaring at us: death. A fourteen-month-old child is not supposed to die--and even though I knew the situation was dire, I couldn't bring myself to face it. So I excused myself, sat down with her son's chart and stared blankly at it.
I first met Tyrek and his parents when he was just three months old. Tyrek had Down syndrome, clubbed feet and a large sternal scar on his chest from surgery to repair a complicated heart defect. Despite his bad luck, Tyrek's most impressive characteristic was his cheery disposition. His mother was a tall African-American woman with straightened hair and warm eyes that always appeared weary. Tyrek's father stood well over six feet, a sharp contrast to the "little man" he held in his arms.
I became Tyrek's pediatrician through a referral from a cardiologist who knew that I care for children with special health needs and that I happen to have a son with severe autism. Tyrek's parents and I bonded quickly, our conversations more animated and collaborative than the typical doctor-patient exchange. Tyrek always arrived at the office cradled in his father's massive arms and with at least one foot casted. I relished these visits because his parents were always so proud of Tyrek's accomplishments and always let me share my latest story about my own son, Sean.
Sean has difficulty communicating. Yet when we met Tyrek and his parents by chance at the neighborhood Staples, Sean wanted to touch Tyrek's cast. Carefully, Tyrek's mom explained that the foot wasn't straight, so the doctor had put it in a cast to fix it. My son nodded and said, "Good boy Tyrek!" as we all smiled approvingly.
Those smiles faded from my memory as I found myself back in the ICU.
Tyrek's mechanical heart valve had not been working properly, and the surgery to correct it was unsuccessful. I stood beside Tyrek's bed and stared at the monitors while his mother sat on a makeshift bed. I was convinced that he'd pull through. He'd already beaten most of the odds.
When I was a resident, the nursing staff and other residents would look to me to lighten a difficult moment with humor. Now, with Tyrek's mother, I mentioned a conversation my youngest daughter, Maya, had had with me about her older sister, Claire. She'd said, "If Claire can play the clarinet, how come I can't play the Maya-net?" Tyrek's mom smiled for a moment.
Even as she did so, something inside of me wanted to reach out, embrace her and tell her that I was sorry I could do nothing. Instead, I resisted it and went home for the weekend.
I came to regret that decision. Tyrek died a few hours later.
Even though I had left my twenty-four-hour pager, home phone and cell number with the parents and staff, no one contacted me when Tyrek passed away that Friday night.
Maybe his parents and the staff felt that I'd already said my goodbyes. Maybe they thought that I would be busy playing with my kids. Maybe they were worried that I would feel guilty or depressed that Tyrek didn't make it. Or maybe they didn't give it a second thought. I felt cheated--even disappointed--by the staff and by Tyrek's parents for not notifying me. But inside, I felt most upset at myself for not seizing the moment earlier when I'd had the chance.
Now I had to wrestle with closure. I felt all the remorse I hadn't expressed at Tyrek's passing. At the same time, I couldn't bring myself to go to the funeral or wake; instead, I sent a letter of condolence. It simply said, "My deepest sympathies, we will all miss Tyrek. Dr. H. and family."
I wish I could say that Tyrek's parents responded to my letter with some reassurance that they'd felt my last hours with them were important. I never heard from them, and I'm left to wonder why. I think of the words of the English writer Joseph Addison: "Friendship improves happiness, and abates misery, by doubling our joys, and dividing our grief." I feel painfully aware that I missed a special opportunity to let down my guard as a doctor and, by acknowledging the friendship I felt for Tyrek and his parents, to share our common grief and our humanity.
About the author:
John Harrington MD is a board-certified general pediatrician and the father of Claire (fourteen), Sean (twelve) and Maya (eleven). He is the new division director of general pediatrics at The Children's Hospital of The King's Daughters (CHKD) in Norfolk, VA. "Writing has always afforded me the chance to go back and replay moments in time where I was conflicted and perhaps emotionally exhausted as a physician. It provides an opportunity to regain perspective and insight on many different levels."