Attending Children: A Doctor's Education (review)

One of the maxims often recited to medical students who are just beginning a rotation in pediatrics is "Children are not small adults." The practice of pediatrics most diverges from adult medicine in how it must take into consideration the developmental stages of children as well as their families' opinions and values. Although in recent years there have been many narratives written by physicians about practicing medicine in an adult setting, there have been comparatively few written about practicing pediatrics.

Not only does Margaret E. Mohrmann, in Attending Children: A Doctor's Education, discuss what it has been like to practice pediatrics over a career spent in academic medical centers, she also provides narratives that instruct medical students on how doctors learn to care for patients as opposed to how they acquire scientific knowledge. Organizing her book around three definitions of the word "attend": "to listen to," "to accompany," and "to wait for," Mohrmann presents stories that showcase paradigmatic examples of key patient-physician interactions rather than illustrative ones. An illustrative example is "something already known or formulated," whereas a paradigmatic example reveals something "previously unthought or uncomprehended" (6). This kind of revelatory patient-physician encounter can lead to epiphanic knowledge, a kind of knowledge that Anne Hunsaker Hawkins describes as "experienced as abrupt and total and 'all of a piece'—it is not knowledge arrived at through discursive reasoning."¹

For example, Mohrmann recalls meticulously consulting textbooks and more experienced professionals when she was a first-year pediatrics resident trying to find the right dose and dosing schedule of a narcotic to help alleviate the pain of a spinal cord tumor, only to hear her patient say, "Dr. Mohrmann, fix me!" (25). These cries of pain frustrated Mohrmann—"I hated it; sometimes I even thought I hated her" (24). Not until she decided to "practice medicine" (26) and deviate from conventional wisdom by increasing the dose of pain medication and checking on her patient more frequently to see if the interval between doses needed to be shortened did she come to realize that not everyone's pain fits a predetermined schedule. As a result, "in fewer than twenty-four hours, [her patient] was a changed person" (27).

Mohrmann's writing is both scientific and literary. Information about the diseases affecting children is clearly presented, but there are also vivid physical descriptions of children like Milly, "a slim seventeen-year-old who wore her sandy hair pulled back from her pale, freckled face into a braid that followed her spine almost to the end" (23), and metaphors that enhance the presentation of the material: the unremitting pain of a spinal cord tumor is a "crab chewing away at her spinal cord and most of its nerve tracts" (24); the side effects of chemotherapeutic agents are "chemical bludgeons" (52); the discomfort a hospitalized child feels being in the "spotlight"—when the medical team discusses her illness during morning rounds—is "like a searchlight scouring the grounds of a prison compound" (53); the anxiety of watching a neurosurgeon trying to place a catheter inside a ventricle is like "envision[ing] a little bulldozer taking out pieces of the landscape with each pass: there goes the dog's name, there the first song I learned in kindergarten, there my newfound skill at pedaling a two-wheeler" (110).

Another aspect of Mohrmann's book that distinguishes it from other physician narratives is its discussion of empathy and religion. She gives many examples of what Helle Mathiasen and Joseph S. Alpert would characterize as natural empathy, which does not require personal suffering, compared to empirical empathy, which does.² Although the ability of physicians to naturally empathize with their patients is a desirable quality, physicians' own perspectives and experiences can lead them to misuse it. Mohrmann writes about the perils of "presumptuous" empathy—as if understanding how a patient feels "by listening, paying attention, being present" (156) permits health-care providers to therefore say, "I know how you feel," or...