When you find yourself apologising to the medical student for the unplanned look into the mind of a rapidly burning out paediatrician, it may be time for a holiday.
Last week’s clinic list started off in pure chaos – patients turning up late and overstaying each consult, people losing their scripts and turning up, crowing at the front desk administration team, demanding stimulants like our public paediatric clinic was the 109 tram going through Victoria Street.
Students flooded the entire joint on assessment day, all quavering with fear of their assessor’s mounting irritation. Children were tearing up the waiting room as their parents stared at phones or yelled at spouses about why they were seen going up Punt Street with a cream horn.
“Next time we feel our anger rise up, let’s take a nice deep breath and regulate ourselves before we manage the child’s behaviour.”
I’m teaching yet another set of angry parents how to regulate one’s own emotion to then be able to do so for the child, but they are choosing to spend their time going off at their paediatrician that their two-year-old has ADHD.
In the background, I can hear Outlook and Teams having an absolute ball throwing out notifications every other minute, trying to outdo each other in some macabre version of a rap battle to advise me that apart from this consult, I’m apparently failing at fixing everything else.
I tell myself to relax and to focus on what is within my area of control. The parents are under so much societal stress and the barrage of social media misinformation is so real.
It’s not about you, York, it’s an unhealthy and potentially harmful societal shift borne on the winds of vile policies, as the world disintegrates around us into greed and debasement of basic humanity and it’s somehow our issue to solve together.
Relax.
I made an attempt to at least, punctuated by a child and their two older siblings tearing things apart in my clinic room while the parent emotionally dysregulated in my direction.
“Let’s learn to experience the world through the child’s perspective, so we understand why they behave so angrily and are biting people,” I say, punctuated by a yelp and tears from the corner as the two-year-old bites his older sibling’s arm.
We discussed that an occupational therapist or play therapist might be able to help the child regulate with the family, and right before the consult progresses to the high stakes topic of parental mental health management, there’s a wild cackle as a child launches a toy at my head.
I caught the toy deftly, like all paediatricians do with child-sourced projectiles, and put it next to my keyboard, looking into the soul of the toddler who’s grinning back at me. Matched the cheeky grin with an uncharacteristic icy snarl.
Hand me that wooden spoon, Gerry.
I could feel my soul leave my body and, in detached amusement, watched myself saying “I’m not having any of this”, picking up the very instinctively scared toddler who was frozen mid-action while stabbing a toy and putting them into their dad’s arms and telling them to be quiet or leave the room.
Cold and monosyllabic. Short sentences made up only of full stops and very small fonts. Those are the two choices.
Everyone in that room, including myself, knew we were in trouble. Dad deflated from his masc4masc brand of posturing and scampered out of the room with the toddler, who was still stiffly holding the half-mutilated action figure and the older sister who had attached herself directly to her dad’s hip and left without prompting.
She lisped a quick “thank you” and closed the door quietly behind their retreating backs and I heard the slam of the other door that bordered the waiting room.
I wish I could say the consult improved with the removal of chaos from the room but unfortunately, we’d managed to find ourselves rudderless.
Without a punt between us, the conversation continued to circle, as the remaining parent now pivoted to trying to convince me that the throwing of toys was a sensory preference for the PDA, secondary to autism, secondary to something they’d seen on TikTok.
This is where I normally could marshal the empathy to continue negotiating a path forward with families and re-examine basic childhood psychology. Try to get them there in a stepwise fashion, ignore all the ridiculous social media pop psychology that is unoriginally cited by every family that comes into all our doors.
Normally, I can also ignore the unending stream of e-mails from medical workforce about sick calls, endless meeting reschedules with agendas that barely move anywhere, end of term references, planning sessions for neonatal simulations that nobody attends anyway, medical student complaints.
But not today, because we’ve run clean out of bloody punts.
There’s no more gas in the tank and there’s a very suspect personal life laying in the trunk of the car with the big clock making a disturbing ticking sound ready to go up in smoke.
It’s all too much, and I can’t handle another pointless discussion before lunch on a whole day of consulting.
So, a unidirectional diatribe on looking with cold eyes at the state of things is all I can manage today, thank you. Here’s the plan, come back to see me in six months, and if you haven’t done any of it you will be discharged. Now leave.
I closed the door behind her, swearing profusely under my breath and turned around to see my forgotten medical student in the farthest corner of the room very successfully blending into the wall and contemplating their life choices.
Jesus wept.
Apologising profusely to the medical student for the unplanned in-depth look into the mind of a rapidly burning out paediatrician, I tried to coax our day back into usual form.
Plastering on a smile that could only be more terrifying than my previous display of disembodied cold rage, I clicked on the next patient.
Let’s do some educating. I do love that aspect of my work after all. Teaching is so grounding, you know; it just reminds us all how far we’ve come, how we’re all part of the same community, trying our best to help humanity in pursuit of health in a holistic way.
“Dear paediatrician, please see two-year-old boy for anger issues, parents think child has ADHD.”
Might be time for a bit of time off actually.
Dr York Xiong Leong is a general paediatrician in Eastern Health, Melbourne, working in public inpatient and community paediatric services, and a medical educator with Monash and Deakin universities. One of the best compliments he has ever received is “Babe, you barely live on this planet”.
