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Weaving a new future for pediatrics
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Oh, how do you solve a problem like Maria? How do you hold a moonbeam in your hand? — Rodgers and Hammerstein, “Maria,” Sound of Music, 1959
It takes a village to raise a child. — African proverb
I think I’m goin’ back To the things I learned so well in my youth I think I’m returning to Those days when I was young enough to know the truth/ But thinking young and growing older is no sin And I can play the game of life to win/ Let everyone debate the true reality, I’d rather see the world the way it used to be A little bit of freedom’s all we lack So catch me if you can I’m goin’ back — Dusty Springfield (Carole King, Gerry Goffin), “Goin’ Back,” 1966
I wish to weave a tale of two stories — both joyful moonbeams — in order to illuminate a charmed past and portend a better future. First we must understand moonbeams. What is a moonbeam, and why do people sing about them and try to hold them in order to solve a perceived problem? I turn to my Irish side for an answer.
While the etymology of moonbeams is murky, its meaning may be revealed by an old Irish blessing that speaks of the warmth of sunbeams and the charm of moonbeams. A moonbeam is surely an illusory image, but powerfully enchanting. The reality that I know is truly magical is the joy of general pediatric practice. Ensuring its future is a critical mission and its successful present hopefully not merely a fleeting moonbeam.
The reasons for such joy are likely as varied as we are as pediatricians: Most reflect our foundation as physicians; seeing our patients and their families grow and succeed is one among many; having colleagues and former trainees flourish is yet another. I would like to tell you about two recent experiences that reinforce the powerful, even mystical, forces involved in the joy of what we all do in our practices.
Theatrics of practice
This spring I had the opportunity to see the Broadway National Tour production of “The Sound of Music” in Boston. Playing the lead as Maria was a 21-year-old patient of mine, Kerstin, and during my earlier years in practice, I had charted her and her older sister’s growth and development. Kerstin’s passion is theater and when plucked from college, without previous national exposure, her voice and stage presence stole the show, garnering critical praise in every visited city.
Most gratifying was meeting up with her support group at the stage door following the production — mother, family, high school instructors and drama teacher and friends — and being overwhelmed by the realization of the truth in the “takes a village” proverb. Seeing everyone’s joy was deeply moving.
Moving forward by ‘goin’ back’
Catch me if you can as I return to the days of my youth (relative, of course) when I knew the truth (also relative) and freedom that was allowed in a dimension that is currently lacking in the world of medical training. My second vignette stars a former trainee, practice partner, and now academic pediatric subspecialist, Denise. Returning to her proverbial home for Grand Rounds late this winter, Denise’s tale reinforces the dark void in our current educational paradigm. Hers is a story that needs reckoning in order to right the current ship of fools before the multigenerational shift becomes irreversible.
Denise began her professional career as a nurse, then came to Vermont as an OB-GYN intern, before seeing the light and changing to our pediatrics residency. She worked with me in my office for a year after completion of her residency for two reasons: one, to prove to my practice that we could accommodate an additional physician; and two, to prepare to move on to a fellowship in pediatric hematology/oncology, passing her successfully created position to her close friend and now 2-decade partner of mine.
In fellowship, she found herself in a clinic space shared by dermatology and, more importantly, with patients with vascular malformations whose condition enlisted no academic home. In the day of paper charts, shared space, and without helicopter attendings, her curiosity and passionate interest in providing excellence in care led her to enlist multispecialty clinical and eventually research interest in these tumor variants. She later went on to direct a clinical and translational research program in vascular malformations and tumor biology, all the time pushing for true quality of care improvements at the local, national and international level.
Passion without limits
Responsibility without overdone oversight allowed a self-directed attack both intellectually and bureaucratically, all driven by the story line of patients and their families. Such an endeavor took engagement and support from true leaders who understood her mission and discerned her potential to make a contribution — chairs, mentors close and far, and institutions — children’s hospitals, in particular, which are so dear to the cause of promoting the well-being of all of our children.
Back to voice
Does our current paradigm for medical education allow for the curiosity of trainees to flourish? Or does it reward the “doing” of learning: the going through the motions that clever students realize will be labeled as “correct” rather than engaging in that essence of medicine handed down to us by our heroes?
As Dusty Springfield alludes to in the Carole King/Gerry Goffin song above, let our medical educators debate the true reality as only educational school wannabes can. I prefer to see the world the way it used to be because it was a better world, and indeed, a little bit of freedom is all we lack — and the collective voice to sing to that powerful tune.
As pediatricians, the power of voice derives from the village. As physicians, the permanency of voice depends on the passing of knowledge to the next generation. Both our villages and our academy are in peril, cracks to the core evident. We must collectively act. We must harness the joy.
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- William T. Gerson, MD, is clinical professor of pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. He can be reached at 52 Timber Lane, S. Burlington, VT 05403; email: William.Gerson@uvm.edu.
Disclosure: Gerson reports no relevant financial disclosures.