Every day during rounds Jeremiah*, a toddler with a congenital illness and severe developmental delay who required intense care at home, lay silently in his hospital crib, back arched, thin limbs still. In the year that I had known him I don’t think he ever looked at me, though I was fiercely dedicated to him and his family.  I also don’t know if he was able to remember me from one day’s rounds to the next or from admission to admission. He certainly knew nothing of the time I spent outside the room advocating for him and his parents.  When he was at home he had many appointments, continuous feeding through a tube in his stomach, medications given on a schedule, and needed constant attention to keep him well. Jeremiah’s family, though, was trapped in the web of poverty and circumstances that ensnares so many of my patients, and they weren’t meeting his complex needs.  During each hospital stay I tried to get help for them but their challenges were convoluted and impenetrable.

As a result, the last day of his last hospital visit was different. The crib rails were down and the mattress bare save the translucent white hospital sheet. His mother had neatly packed all of his belongings into sturdy plastic shopping bags and she cradled his frail body in her arms during rounds. Jeremiah stared into his mother’s eyes and I realized that I used to wonder if he was blind. I knew then that he was not. There was love in their locked gaze, and it took them deep into each other’s soul and body. There was love between them but it wasn’t what he needed to run his feeding pump, get him to his appointments, and keep him out of the hospital.  Jeremiah couldn’t have understood that despite my best efforts he would be leaving the hospital with another family that day, until his own was able to care for him again.  I teared up as I left the room. How would he connect with another woman’s eyes?

I drove home from work late that evening, my thoughts heavy and twisted. I couldn’t get Jeremiah’s sight, his family, his new life, out of my mind as I merged into two lanes of traffic. At the curve on the highway past the hospital, my watch buzzed a notification. Just as my right wrist pivoted inward to turn the car through the curve, I swiveled my left wrist in the opposite direction to see my watch. I accidentally straightened the steering wheel.  My car crossed the white-dashed lane line on the passenger side.  Suddenly the arc of the overpass above me was more oblique than I was used to over thousands of drives through that same curve.  For a moment the cars in the slow lane and the beat-up metal guardrail on the far right loomed closer.  I caught my breath. With both hands I jerked the wheel back to the left, shaking but lucky and unscathed. 

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*All identifying details have been changed to protect the patient’s identity