Children + Trauma Trump Ego.

There is never a time that a parent should, at the conclusion of a conversation with a medical specialist of their child's, feel shaky and scared.

"She isn't traumatized, you are." Said a doctor to a mom who's been in the hospital for over 50 admissions with her 5-year-old daughter who wasn't expected to live as long.

Fair to think, not fair to say. Any child admitted even once can experience trauma associated with the event. More to the point, so does the parent because as any parent knows, we experience the woes, troubles, and accidents of our children in tandem. This is not to say what happens to them happens to us, rather when something happens to them, something happens to us. Is it reasonable to think that a parent who has been by their child's side through 50 hospital admissions and the emergencies that necessitated them is traumatized by it all? Sure. Find me a connected parent who isn't.

The care we give at home as parents is what doctors and specialists write up, but don't have to do themselves. So, it makes sense that it is difficult to grasp why a parent might be traumatized if you aren't living the emergencies, supporting children through admissions and more challenging: doing it when your child is medically complex, has behavioural challenges, or cognitive impairments that make each visit to the hospital exponentially more challenging.

Likening a medical indication or prescription to a business recommendation, I can tell you that posting relevant content on your subject matter is important to do weekly. I can put together a strategic plan, give it to you and go on to the next client. But unless I am the one doing the research about what is timely, trending, or relevant to the target audience, making sure I am clear about their preference for engaging with that content, creating the editorial calendar, writing the copy, designing the graphics, setting out the layout, the SEO, the appropriate sharing at the right time and via the right channel for the type of content, I don't actually know how taxing it is. How much time it takes, and how much skill is involved in doing it right.

This is why when a client looks at me exasperated because they don't have the resources to implement what I know are the right things for them to do to accomplish the goal, I need to listen. I need to find a way to make it possible with the resources they do have and I need to make sure that when we all sign off on what the next step will be, they feel good about it. They feel that it isn't beyond what they can handle - even if it's something they've never done before.

That's the role of physicians too. Delving into what it's like at home for a patient and their caregiver can deliver a level of care that is life-changing. Certainly, less trauma-inducing. When my daughter was admitted to the children's hospital experiencing copious amounts of vomiting from the formula given through her Gtube, I asked for us to have a multi-team meeting that included the pharmacist. I wanted us to talk about what medications were options, meds could be switched for others that had multiple indications, and I wanted us to explore non-pharmacological options that could be implemented to alleviate the strain on her and our washing machines. To say that it was brutal to see my child never gaining weight and suffering vomiting all day after every feed is an understatement.

When we met as a team, they asked how I felt about real food blends and whether I felt I could manage to blend food at home. It was my favorite thing to hear. I dove deep into learning about micro and macronutrients, consulted with various dieticians and nutritionists, and kept my daughter's nurse practitioner informed of the progress. The vomiting stopped overnight, within one month she wanted to try food by mouth again, and by six months all her meals were taken orally, leaving the Gtube for meds and water. In the meeting, they sought to understand what I could handle. The doctors left whatever ego they had out in the hall and inserted themselves into what a day in our lives might be like and came up with a solution that changed the course of my daughter's wellbeing.

Do you think I left that discharge shaky and scared? No, not one bit.

At-home care is ever-increasing, placing reliance on parents and primary caregivers to do what nurses do, what personal support workers are trained to do. On top of being parents. To say that a parent is traumatized after receiving the piping hot bag of shit that is a diagnosis is a no-brainer. To consider that they would be traumatized after multiple emergencies leading to admissions or disease-specific reasons for a hospitalization ought to be deemed the norm and the way parents and caregivers are spoken to and treated needs to reflect it.

Parents change G-tubes and vent their kids, suction their kids, change dressings after major surgeries, administer dozens of medications around the clock. We do physio on our kids and occupational therapy too. We massage and stretch and strengthen them. We change grown children, dress and feed them (one way or another). We are trained to become keen observers, clinicians even. We become experts on our child's condition and how it manifests and unfolds specifically in our children. Our children have a team of people looking after them in one person: the primary caregiver, usually their mom.

So yes, the mom at the start of this post was traumatized. Her concerns were something that the doctors she was interacting with should have responded to with deference and treated her with the respect hard-won by her experiences. Because the care the traumatized parent gives directly and profoundly affects the care the child receives. We are human, tendons, and organs, and bones, and souls even though we seem to carry on like machines.

Dismissing issues raised as being due to parental trauma is an issue of ego, and there is no room for ego in the proper care of people, particularly children, who keenly absorb what is said and done around them, who form an understanding of the world around them and of themselves via interactions with others.

It doesn't even matter whether or not you want to be a worthy physician or if you are in this role to make a difference in the quality of the lives of your patients. If you are a medical doctor who works with people, assume that parents of children with disorders, diseases, and other medical complexities who come to see you with their children are traumatized by some or all of the processes that being a caregiver entails, and equally assume they know what they're talking about. That alone will raise the standard of care in meaningful and tangible ways.