Rescue Fantasies

RMS Titanic. Photo credit: Wikipedia Commons.

Dr. Coplan unloads on the hardest part of a pediatrician’s job

What do you suppose is the hardest part of my job as a pediatrician? If you guessed “Giving bad news,” you would be wrong.

Make no mistake about it: giving bad news is never easy:

1. Your son / daughter has died.
2. Your son / daughter has :

• Cerebral Palsy
• Intellectual Disability
• Autism
• Brain Damage
• Spinal cord injury
• Cancer
• A degenerative disorder for which we have no treatment
• Other [fill in the blank]

Surprisingly, however, giving bad news is not the hardest part of my job. Properly done, giving bad news is an act of compassion that sustains parents and helps to assure that family healing will (eventually) take place. Giving bad news requires me to practice my profession at the highest level. As painful as the process may be, it offers me the satisfaction of a difficult job well done.

So, what is the hardest part of my job?

In episode 23 of The Twilight Zone (The Nightmare at 20,000 feet), a passenger (played by a very young William Shatner, pre- Star-Trek fame) spots a monster on the wing of the airplane, and watches with horror as the creature slowly begins to devour the wing of the aircraft. This plot device forms the basis for innumerable movies: Only the protagonist sees the danger– everyone else is placidly unaware. The “Invasion of the Body Snatchers” is another great example: The hero struggles to stay awake. Everyone else is either ignorant of the danger, or their minds have already been taken over. (Written and produced during the McCarthy Era, this film is also a metaphor for America’s fear of creeping Communism: Substitute “Reds” for “alien pods,” and you get the idea.).

I have recurring nightmares about the Titanic. Typically, I am standing on deck as the ship slowly takes on water. Sometimes I make it into a lifeboat, or rescue vessels arrive in time. But usually not. These are my sleeping nightmares. My waking nightmare is even worse: Like Will Shatner, or the hero of The Body Snatchers, I alone see the approaching danger. I try to warn them: Watch out! Slow down! There’s ice ahead! Don’t you know you’re going to die? But they never listen, and the immutable events unfold as they always do.

So, you see, the worst part of my job is not giving bad news. It’s rescue fantasies.

“I am the Master of a thousand ships. One of them is going to hit the iceberg, and I don’t want it to be yours.” This is what I tell parents. Some parents heed my advice and some don’t — particularly when it comes to seeking mental health services. After following through on my advice, one mother gratefully confided: “Doctor Coplan, you have helped our family in more ways than you will ever know.” I am sure she is right, and I have an inkling of what she may be alluding to, in so far as the ripple effects of mental health intervention are concerned. On the other hand, one father declared: “I don’t want any therapist putting thoughts into my child’s head,” and angrily pulled his family from follow-up. These families are steaming full speed ahead into pack ice, and there’s not a damn thing I can do about it. I see it coming, I know how it ends, but there’s nothing I can do except wait for the crash. I can only console myself with the realization that I did the best I could. But it ain’t easy.

All of which is preamble to the real subject of today’s blog post: The Office of the Child Advocate of the State of Connecticut Report on the Newtown massacre. Reading it as Developmental Pediatrician elicited nearly overwhelming feelings of despair and fury. Read the report yourself over Thanksgiving break. Next week we’ll start to unpack the contents.

Until then.

James Coplan, MD is an Internationally recognized clinician, author, and public speaker in the fields of early child development, early language development and autistic spectrum disorders. Stay connected, join Dr. Coplan on Facebook and Twitter.