Sometimes, events we consider insignificant turn out to have a long-lasting impact. I was reminded of this recently when I received an email from Erin, a graduate of our pediatric residency training program. She wrote to remind me about a visit we’d made years before to the Bronx Zoo. Though I’d barely remembered that trip, the day’s events clearly had had a lasting effect on her.
* * *
It was a Thursday at the end of February 2002. I’d spent that month as the official attending physician on CHAM-9, the Infants’ Inpatient Unit at Montefiore’s Children’s Hospital, and was scheduled to complete my month of service the next day. Although being chosen to do attending rounds was an honor (there were only 24 attending slots each year on the Infants’ and Children’s Units, with more than 100 attendings eligible to fill them), it was also a tremendous amount of work. I was responsible for every patient on the floor; to be certain that I knew what was happening with each child, it was necessary to spend four to six hours each day rounding with the residents, visiting and examining each kid, speaking with his or her parents, and writing daily progress notes. During these hours, in addition to making plans for each patient’s management, I was also expected to teach the residents and medical students about the conditions that had led these children to need one of our beds. This was in addition to my regular responsibilities, which included patient care, medical education, and administration. My workdays that month had been long and stressful.
But the stress I was under was nothing compared with what the interns and residents were experiencing. It was winter, so the ward was constantly at full capacity; as soon as one child was judged healthy enough to be discharged, another would arrive to take his or her place. Our beds were filled with kids with an assortment of chronic illnesses and various types of cancers, and there was a steady stream of previously healthy kids now laid low by the flu and other infectious diseases. Our patients were sick, and that month, the interns and residents charged with keeping these kids alive virtually lived in the hospital, being on call every third or fourth night, arriving at work before the sun rose and leaving after it had set. They never saw daylight.
Though they worked their asses off and did their very best, they were not always successful in accomplishing their goal. Four of our patients died that February, each a difficult and terrible tragedy. By the end of the month, the house officers were completely drained, chronically overtired, and sleep-deprived.
Sad to say, all of this was pretty much standard during February at any children’s hospital in the Northeast. But during that February, we were suffering from the effects of an added stressor: only four months had passed since September 11. On the morning of that terrible day, out the windows of that very ward, many of us had watched the smoke rising from the Twin Towers located only 10 miles to the south. The implications of the tragedy had been hanging over all of us, but in the hectic months since, few of the house officers had had the time or emotional energy needed to process these events. The interns and residents carried this around with them every day. Everyone, from the most junior medical student to the most senior resident, was deeply depressed.
* * *
From the first time I’d ever been invited to serve as a ward attending, I’d made sure that near the end of the month, I took the ward team out of the hospital on some sort of outing. Based on my own intern experience, I understood how spending all that time in the hospital wore on one’s body and soul. At the end of my month as an intern on the infectious disease ward, as a way of thanking us, our attending had taken the team out for lunch at a local restaurant. Though that trip had lasted only an hour, it had made a tremendous difference: being able to breathe fresh air, enjoy the sunshine, and see average citizens walking on the street had had an amazing effect on my psyche. So when I became the attending, I’d made sure to offer every team I worked with the chance to do something fun outside the hospital.
Though I left to the residents the choice of what we’d do, because we were in the Bronx, most every group wanted to go to the zoo. The group I worked with at the end of February 2002 was no exception.
* * *
That Thursday morning, after meeting in the hospital’s lobby at 10 a.m., our team, consisting of three med students, four interns, two residents, and me, piled into two cars and started off on the short trip to the Bronx Zoo. Prior to leaving the floor, the senior resident had signed out our 22 patients to the chief residents, who’d volunteered to cover while we were gone. (The chief residents were the heroes of these trips; had it not been for their generosity and kindness, our outings would not have been possible.)
Our plan was that once we’d arrived, we’d walk around for an hour or so, looking at the animals and the people while enjoying the fresh air and sunshine; then, before heading back, we’d have a quick lunch in the zoo’s Dancing Crane Café.
It happened to have been a beautiful day. Though it was a bit chilly, with the temperature in the high 30s, the sun had been shining, and the air had been clear and free of wind. While walking through the entrance, I noticed that for the first time all month, everyone was smiling, even Dan, the intern who’d been on call the night before, who had been up all night with sick patients and who looked as if he’d been shot out of a cannon.
We began walking. We passed the World of Birds and Tiger Mountain. We passed three groups of children, and their teachers, out on class trips, enjoying the morning. We saw the bears and the baboons in the Himalayan Highlands. Everyone seemed happy and relaxed and relieved.
Everything seemed perfect. But then we saw the giraffes. And everything changed.
* * *
When we reached the giraffe enclosure, Erin, who was one of the interns, said “They’re beautiful! They’re just so beautiful!” And then she broke into tears. Dan added, “So beautiful! How can people be so cruel when there are such beautiful things in the world?” And he, too, started crying.
Within a minute, every one of us was in tears. The dam had finally burst. All at once, the sadness, grief, terror, anxiety, exhaustion, and shock that had built up over the preceding months had bubbled up to the surface. We were engulfed in a group sob session.
It lasted for maybe five minutes. Toward the end of that time, I had begun to get worried. With everyone consumed in tears, I wasn’t sure how I was going to get them back to the hospital. But we got it out of our systems quickly. Five minutes of crying, and then we moved on.
We left the giraffes, walking past the Congo Gorilla Forest and ultimately reaching the Dancing Crane Café. After a quick lunch, we headed back to the parking lot, piled into the cars, and made the short trip back to the hospital.
As scheduled, I finished my attending rounds responsibilities the next day and returned to my regular work life. Consumed with other issues, I quickly forgot about the experience at the giraffe enclosure.
* * *
Seventeen years have passed. A lot has changed: the hospital has gone to a system in which hospitalists cover the wards, eliminating the need for nonhospitalist physicians to serve as attendings. My last month of attending rounds occurred more than 10 years ago.
Because of this, I’ve become disconnected from the house staff; I meet with the interns and residents a couple of times a year to talk to them about medical genetics, and I get to know the few who choose to do an elective in my field. I hadn’t even thought about these trips to the zoo until two weeks ago, when, out of the blue, I received an email from Erin. Here’s what she said:
“Dear Dr. Marion,
You may not remember me. I was a resident at Montefiore and went on to do a pediatric emergency medicine fellowship.… I now work as an attending in the ER of a children’s hospital in the South. Last weekend, when we had a break in the action, I had some time to tell my intern and resident what it was like in the “old days.” This was prompted by complaints about how hard they were working. After telling them what was expected of us as residents, I shared with them one special event I remembered. The single most meaningful day of my entire residency was in February 2002. You were our attending on CHAM-9 and you took us to the Bronx Zoo. You told us that we were beaten down as interns, hadn’t seen sunlight, and had experienced far too many deaths.
That trip to the zoo was such a lifeline. It showed us normal, happy children and got us out of our existentialist experience that all kids had horrible diseases. I especially remember visiting the giraffes that morning and seeing how beautiful they were. It was a transformative moment.
I just wanted to take a minute to thank you! You need to understand what a huge effect such a small act had on us when we needed it more than we could know.
I am the doctor I am because of my experiences at Montefiore and Einstein, having had those experiences shaped by attendings such as you. Thank you.”
Erin’s email brought tears to my eyes. I realized how much I missed those trips. And for the first time, I also realized how much those trips meant to others.