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As a medical student, we were on the wards at the hospital starting in our third year. This means that after two years of books and lectures, we were helping to take care of actual live people.

I started in pediatrics.

Fun, right? Kids with ear infections, coughs, colds, strep throat and I get to help make them feel better.

No, not fun. Not pediatric clinic. Pediatric ward, meaning the hospital ward, and at a big tertiary care hospital. Tertiary care is where the complex cases, meaning children who have something Really Bad, go.

I was assigned a group of children to follow and help take care of. This was the stuff of nightmares.

A two year old with a brain tumor. Inoperable. He was getting radiation. His parents had prayers taped to the inside of his crib. His first symptom was when his walking deteriorated. Then he started to vomit. His parents and family and friends prayed by the crib every day.

A five year old with liver failure. It was very very difficult to draw blood from him after so many hospitalizations. His veins were scarred. I held him one night and talked him into holding still while the technician stuck the needle in the fourth and then the fifth time, to draw the necessary blood.

The child with seizures was a relief. Her seizures were diagnosed and she was responding to treatment. The MRI had not shown a brain tumor. No one had witnessed the seizures except mom until she was hospitalized, but the neurologist said that the flashing lights of the new video game machine on the ward were tremendously useful. The lights induced the seizures very nicely so that we could see what they were. She would go home.

The worst for me was a five year old who had been beaten in the head with a two by four. I am not kidding. This meant that at long last he would be taken away from his drug addicted mother. It was the mother's boyfriend who had beaten him. As the boyfriend was taken into custody, the mother hung on the arms of the police, saying, "No, no, I won't press charges, he didn't mean it." There were witnesses, including the police, so the boyfriend went to jail. Again.

The real horror was that this child had grown up where people beat each other and hit him with two by fours. We had to keep him in a locked, roofed crib, because he was so cruel to other children. He rode on a tricycle in the hall for a bit and we were initially happy to see his joy. Until he invented a new game: ram other children, standing, sitting, in wheelchairs or on crutches. He could barely talk but was inventive as could be. We could not turn our backs for a moment.

The social worker spoke of him with despair. "There is no foster home that could handle him. He will have to go to an institution. And he'll stay there, because they won't have the time or staff to teach him. And it would be a 24 hour job to try to repair the damage."

He looked feral in his locked crib. And the emotions that I felt are vivid as ever. And we didn't talk about it. The attending physicians didn't, the residents didn't, the interns didn't and so we, the medical students, followed their lead. We did not discuss our feelings. We learned not to weep.

Horror, horror, horror.

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