The dim lights of the hospital room cast my patient in a soft glow. He was writhing on the hospital bed, crying out, “Mama, it hurts!” It was the middle of the night, and I was halfway through my pediatric sub-internship, during which I functioned like a resident intern despite being a fourth-year medical student. This patient, a 4-year-old boy admitted due to dehydration from a particularly rough bout with a stomach bug, was experiencing abdominal pain. Unfortunately, there wasn’t that much we could do for him other than support him through the illness – but that’s little comfort to the mother of a screaming child. I spent much of the night by the patient and mother’s side – thinking of other ways to help this child, answering the mother’s questions, and trying to feel a little less useless.
Everything came to a head when, amidst the stress overnight, the patient received a concerning test result for another infection. I watched the mother start to pace, becoming increasingly (justifiably) upset that her child had an additional infection. She urgently asked me to interpret the specific test results, posing questions that overwhelmed me but necessitated an answer nonetheless. I quickly said something to the extent of, “Umm, I think this means your child does have this infection, I’m so sorry, let me go check with the rest of the team.” I could see the dissatisfaction and anger on this mom’s face, and I felt that she was dissatisfied and angry with me. And why wouldn’t she be? I was useless – her child was still crying in bed, I couldn’t do anything to speed along his recovery, and now I was unable to strongly give an answer about a new and distressing test result.
With a head hanging low and heavy footsteps, I made my way back to the team room where my senior residents were working. I quickly filled them in on everything that happened and asked about that test result. I learned that I was incorrect in my interpretation – that specific result meant that the patient did not have that infection and that this result indicated that he had been vaccinated against this illness. This was excellent news! No new infection for this child! But my heart sunk at the thought of having to tell this mom, who I was convinced hated me, that I was wrong. Surely this would make her hate me even more. She would probably prefer to be left alone for the rest of the night. Wouldn’t it be better for the day team, people she probably liked more than me, to tell her this news?
But as soon as these thoughts crossed my mind, I saw them for what they were: shame. I had spent my third year of medical school studying shame and the ways medical leaners cope with their shame, including the more destructive and more constructive forms of shame engagement. Despite knowing all this, I watched myself becoming a textbook case of destructive shame engagement. The shame (feeling like I was useless), hiding (scurrying away from the patient and mother), avoidance (coming up with reasons to avoid the mom for the rest of the night) were several classic ways people cope with shame less healthily. While hiding might have protected me and my fragile ego in that moment, my inaction would negatively affect this family while leaving the work for another team to deal with. I would be doing an immense disservice to the patient, the mother, and the rest of the medical team.
I felt like both the marionette and the puppet master, forcing myself to pull my legs up, step by step, until I was knocking on my patient’s door once again. Hesitantly, I poked my head inside the room, certain that this mother would kick me out. As I began apologizing for telling her incorrect information earlier, a look of profound relief crossed her face. She stated how happy she was that her son didn’t have another illness and how glad she was to not have to worry about this for the rest of the night.
As she was smiling down at her son, I realized how wrong I had been earlier. So much of my shame had been wrapped up in thinking that his mother hated me, that I was useless, that I was bad. But really, this mother’s reactions had nothing to do with me, at least not personally. She was understandably frustrated with the situation and upset by concerning test results. Those emotions weren’t necessarily directed at me – they were reasonable responses to a frustrating and confusing situation. And while I initially wanted to hide, I was able to help turn the night into a slightly better one by continuing to work with this mother, to be vulnerable in my apology, to let my care for the patient shine through instead of my shame.
Anna Kulawiec
Duke University School of Medicine, MD Class of 2025
13th January 2025
