Blessings and Sudden Intimacies: Musings of a Pediatric Intensivist

By Greg Stidham and Priscilla Mainardi

An introspective look at how the experiences of an intensive care unit physician helped shape his optimistic worldview during a thirty-two-year medical career.

 

In Blessings and Sudden Intimacies: Musings of a Pediatric Intensivist, Dr. Greg Stidham entertains, inspires, and expresses gratitude for

• Language: English
• Publisher: PathBinder Publishing LLC
• Release date: Mar 30, 2021
• ISBN: 9781735996295

Greg Stidham

Greg Stidham is a pediatric intensivist (intensive care unit physician) who retired in 2012 after a 32-year career in academic medicine. In retirement, he has resurrected his passion for literature and creative writing. He has published a memoir, numerous pieces of short fiction, and creative nonfiction. But his real passion has been and is poetry. Dr. Stidham grew up in Cleveland, Ohio, and attended the University of Notre Dame in South Bend, Indiana. He graduated with a degree in English while completing prerequisite courses to attend medical school. He received his MD and pediatrics training at the University of Toledo College of Medicine in Toledo, Ohio, before continuing his training in pediatric critical care medicine at Johns Hopkins University in Baltimore, Maryland.Following his training, Dr. Stidham joined the Department of Pediatrics at the University of Tennessee Health Sciences Center and LeBonheur Children's Medical Center in Memphis. He started the Critical Care Program at LeBonheur and was Chief of the Division of Critical Care. Later in his tenure in Memphis, he started the hospital's Pediatric Palliative Care Program and chaired the Biomedical Ethics Committee for more than a decade.After twenty-eight years at the children's hospital in Memphis, Dr. Stidham moved to Kingston, Ontario, where he assumed the position of Professor of Pediatrics at Queen's University and Kingston Health Sciences Center. He currently serves as a volunteer grief counselor for bereaved parents through Bereaved Families of Ontario. He continues to live and write in Kingston with his wife, Pam, and Dexter, the last survivor of their ever-evolving pack of rescue dogs. An accomplished writer, Dr. Stidham has published a memoir, numerous pieces of short fiction, and creative nonfiction. But his real passion is writing poetry.

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Acknowledgments

I would like to acknowledge the following individuals, all of whom have contributed to my journey: my colleagues, Mark Bugnitz, Dave Westenkirchner, and many others; Alice McGrath; Paula Prudhomme and her beautiful family; and Cathy Jacob.

Foreword

As a registered nurse, writer, and member of the editorial board of a narrative medicine journal, I have long been interested in matters of health and healing, and especially in stories about doctors, nurses, and patients. So when Greg Stidham invited me to write the foreword for his medical memoir, Blessings and Sudden Intimacies, I was pleased and honored. The subtitle, Musings of a Pediatric Intensivist, intrigued me. As I suspected and later confirmed by reading the book, this is one of the most challenging and at the same time most rewarding specialties in medicine.

Blessings and Sudden Intimacies begins with an encounter with a parent whose son has just died. The boy’s mother, after asking Dr. Stidham’s permission, takes hold of his beard, an emblem of his sense of self. It’s that kind of startling detail, one remembered and deeply felt, that stands out in this story.

Encounters such as this one, with critically ill and dying children and their parents, present the poignant sudden intimacies of the book. The blessings of the title refer to the young patients, families, and healthcare personnel who touch him. But they are also more broadly defined, as when Dr. Stidham writes about his early career at Johns Hopkins that without that training and the opportunity to gain (pediatric critical care) expertise, I would not have had the adventures that blessed the rest of my life. He bears witness to the suffering of his young patients and their families and strives to ease, as well as to understand it, as we all strive to make sense of our own and others’ suffering.

The book is just as much about Dr. Stidham’s personal as his professional life, and the act of writing it is his way of striving to understand how the two have shaped and influenced each other. As I was reading, a picture began to form in my mind: the author standing in a circle, surrounded by smaller circles filled with the family members, friends, patients, and colleagues who populate the book. Arrows point in both directions between the center and outer circles, with double-pointed arrows also connecting the outer circles.

The loose timeline of the book, with chapters arranged thematically, helps to communicate the interconnectedness of the parts of Dr. Stidham’s life. The narrative moves easily between topics — medical school, residency, marriage, fatherhood. It is never hard to follow, perhaps because the early trajectory of Dr. Stidham’s life is fairly straight. He never considered any path other than becoming a doctor. He grew up in Cleveland and excelled in school, then attended Notre Dame and the University of Toledo College of Medicine. In the 1970s, he was a fellow at Johns Hopkins University, which had one of the five pediatric critical care training programs in the country.

What starts to emerge in the narrative is Dr. Stidham’s heightened sense of purpose. He goes on to establish a pediatric critical care program, the first in the region, at LeBonheur Children’s Medical Center in Memphis, where he spent twenty-eight years. He travels to Nicaragua, where he is part of a team involved in both performing pediatric cardiac surgery and helping the Children’s Hospital in Managua develop its own program.

Many medical practitioners experience a life similar to Dr Stidham’s: grueling medical school and residency, a demanding schedule of teaching and clinical practice, poignant and memorable encounters with patients at the most difficult moments of their lives. And many of us share the same life experiences Dr. Stidham writes about: friendships, marriage, birth of children and grandchildren, relocations, health issues, vacations, travel. But not all of us choose to write about them with direct, clear language in an organized narrative that brings his patients and their struggles to life in vivid fashion. And that helps us find meaning, as he has, in the smallest, most fleeting encounters.

He employs the same clear, accessible language to relate the history and background of his specialty and to explain medical procedures and human physiology in a way that makes us feel like intelligent laymen who now know the meaning of terms like intubate and the color of intravenous valium. He balances his narrative with funny stories, letting us in on the sort of silly humor that helps the medical staff get through their days.

Throughout, he conveys his belief that life is extraordinary and that he has done unusual and extraordinary things with his. He maintains an optimistic worldview, a mindset that gives him the empathy and strength needed to sustain a long medical career. He tells his story to entertain, inspire, and express gratitude for the experiences that have enriched his life. Blessings and Sudden Intimacies makes you think about what you’ve done with your life, yet Dr. Stidham leaves you feeling that whatever you’ve done, it’s enough.

He writes with disarming charm: Every life is rich in its own unique way and deserves commemoration. Perhaps it is, in part, for those others that I write, for their rich, but otherwise uncommemorated lives. He reveals the richness of his own life and opens up a way for us to view ours as a series of blessings.

East Dorset, Vermont - December 22, 2020

1- A Sudden Intimacy

Not long ago, on a clear, ebony night so cold that I could see my breath extend a full six inches from my face, and my beard was brittle from frost, I was the pediatric intensivist (ICU physician) on call for emergencies at Kingston General Hospital, in Kingston, Ontario. And I was called that Saturday night as part of the Trauma Team being assembled to greet a helicopter, then still en route to KGH from a small town in northern Ontario some distance away.

The patient was a young boy who’d been hit by a car and had sustained severe head trauma. After stabilizing the boy, the staff at the local hospital loaded him into the medical evacuation helicopter, accompanied by his very distressed father. This was in the early evening.

After the helicopter landed, the medics barreled through the doors of the emergency department, and wheeled the injured boy into the trauma bay. The team comprised a surgeon, an emergency physician, emergency room nurses, a respiratory therapist, and myself, together with a pediatric resident. We quickly and thoroughly assessed the boy. His vital signs were now stable. His chest was clear and his heart sounds normal. His abdomen was soft, without abnormality. There were no signs of fractures in his extremities.

A soft plastic tube inserted into his trachea, his windpipe, was securely taped to the outside of his mouth. A bag filled with oxygen was attached to that tube, and then was squeezed to force life-sustaining air into the lungs of this child, who was making no effort to breathe on his own. In fact, he was not moving at all.

The only obvious signs of trauma were the rapidly increasing swelling of the scalp on one side of his head, and the bruise-circles around his eyes, known as raccoon eyes. These are a hallmark of a fracture in the base of the skull. We shined a bright light into his widely dilated pupils; there was no reaction. Indeed, there was no clinically apparent brain activity at all. We also had learned from the paramedics that the boy had suffered a cardiac arrest at the scene of the accident and had required a full-blown resuscitation.

There has never been reported a trauma survivor who has sustained both a severe head injury and full arrest at the scene.

We completed our assessment and ordered further testing. Blood to examine the oxygen and carbon dioxide content, as well as to measure the acid/base status. More blood to check the hemoglobin and blood cell counts, and the electrolytes, and measures of kidney and liver function. Still more blood for a blood typing and cross-matching to assure that blood would be available for transfusion if it were needed. We obtained x-rays of the chest and pelvis, cervical spine, and the long bones of his extremities. And, lastly, a trip to nearby radiology for a CT scan on the way up to the ICU.

All of this flurry of activity took little more than one hour, during which time I had an opportunity to introduce myself to the boy’s father. He stood silently in the door of a small waiting room adjoining the nurses’ station—a middle-aged man, eyes red, though he was not crying. He made no sound or movement while he stood staring straight ahead. I sensed he already knew that I would soon be the bearer of bad news. I told him we would talk some more when we got to the ICU.

When we again sat to talk, after getting his injured son settled in the ICU room with its many flashing monitors, beeping alarms, and the sound of the rhythmic whoosh of the ventilator, he was calm. Face pale and red eyes downcast, but calm, as he sat close to the side of the bed, holding the hand of his son.

There is no hope for him, is there?

I swallowed uncomfortably, and answered, candid. I forced myself to be clinical, sensing that was what this father needed at this moment: No. His head injury is just so severe. Also, his brain was without oxygen for at least several minutes when his heart stopped. Surviving that is not possible.

Please try to keep him alive until his mother can get here.

I will.

He then went on to tell me that I looked remarkably like his wife’s father, who had passed away just a short time before. That comment did not really register with me at the time, but soon would. I sat with him for a half-hour or so, neither of us speaking. It was not awkward; it was more each of us respecting the space of the other. After a time, I got up from my seat to head to my office where I might be able to close my eyes for a short time. I touched his shoulder, then privately asked the nurse to call me when the boy’s mother was there.

I was able to sleep fitfully, sitting in my office chair with my feet propped up on my desk. It seemed that no time had passed when my pager alarmed, displaying the number in the ICU that I was to call. The boy’s nurse informed me that his mother had arrived, and was in the room with her son.

Quietly entering the room, I stood toward the back, and in a soft voice, said, Hello. She turned, and looked at me. Her face went white, and she put her hand over her open mouth. She looked, literally, as though she were looking at a ghost.

Oh my God!

I said nothing, unsure of what words would help, which might hurt, trying to be respectfully silent.

My husband warned me that you looked like him. He didn’t say you looked exactly like my dad!

I pulled up a chair and sat beside her as she recovered from the shock of my resemblance to her recently deceased father. We talked a long while, and she asked many of the same questions her husband had. I answered them as candidly as before. And I carefully explained in simple, lay terms, the processes that occur after severe brain injury and oxygen deprivation.

When her questions were answered, I apologetically and regretfully excused myself. The sun had by now risen, and I had several other patients in the ICU that I would need to see in rounds. I said I would be back later in the morning, but that if she wanted to see me before then, she should ask the nurse to page me.

Later, my other work completed, I returned, and sat in a small, private waiting room with both of my patient’s parents. They asked me again about his condition, and again I reverted to the clinical self they needed from me. I explained, The biggest issue is that a thorough neurologic exam shows no evidence of any brain activity at all. They sat silently, eyes tear-filled, absorbing that information. And I waited, silent and sad myself.

"I am so sorry to say this, but it is quite probable that your son’s brain is actually dead. But to be able to say that with absolute medical certainty requires that we repeat a complete neurological examination not less than 12 hours after the first one.

If that examination continues to show no signs of brain function, then we can say that his brain is indeed dead.

And what then? they asked in unison.

I explained that brain death is, in fact, death. When it becomes clear and certain that your son is dead, and that we are merely artificially keeping his biological functions working, then we do not continue the supportive treatments — the mechanical ventilator, the intravenous fluids, the medications helping his heart and his blood pressure.

The next part of the conversation was difficult, and though I have had this conversation many times, it is always difficult. Your options at that point include the opportunity to donate organs or tissues to help another child. I would like you to speak with the transplant team so they can give you more information, including what that would involve. If after that discussion, you decide that you do not wish to donate organs, the 12-hour waiting period is not obligatory and, if you wish, we can discontinue the life-support at that time.

I left them to ponder and discuss these options in privacy, but an hour later I was paged and asked to return. They had decided that they did not