A too-early lesson.

Last Christmas, our toddler asked Santa for a stethoscope. While initially “a black one like Mommy’s” was requested, my daughter learned that a pink and purple Dora stethoscope was possible and was impressed with Santa when it arrived. She wore it proudly, even exclaiming loudly during a toilet-training moment: “This doctor has got to Poo!” “Helping sick people,” the gist of our job as emergency physicians, according to my toddler, is simplified to putting bandages on, providing ice packs, and complete healing of all that ails by simply laying the stethoscope on various body parts. The naïve nature of my daughter’s perception is refreshing. To be honest, it is nice to have someone believe so whole-heartedly in one’s ability as a physician to heal, despite truly knowing my limitations. Recently, a young friend of my daughter’s from day care was killed in a car collision. While, as an emergency physician, I am skilled at discussing death with adults, the discussion with a toddler is new territory for me, especially my own daughter. A toddler isn’t supposed to understand the permanence of death, let alone the death of someone her own age. My daughter wonders why the doctors couldn’t fix her friend. She wonders why a bandage or ice pack didn’t help. Just when I think she may be starting to comprehend the situation, she asks when her friend is coming back to day care... and why the doctors couldn’t fix her. My daughter’s processing of this death comes in spurts peppered by totally unrelated, often happy comments. While in the bathtub, she asked if her friend fell out of the car and then started showing off her bubble blowing. At day care, she asked if her friend was coming that day but then quickly followed with giggles over my forgetting her lunch bag on the counter. A children’s grief counselor commented to me that “children have this amazing ability to balance deep sorrow and deep joy at the same time.” Witnessing my daughter experience these far-tooearly life lessons has been heartbreaking. Prior to this event, I envied her naïve perception of both eternal life and that doctors can fix everything. I admit that I enjoyed being celebrated for my work at home after long shifts of facing the reality that humans are so vulnerable to chance and that we as physicians are often quite limited in our abilities to help some. The end of my shift now brings pointed questions about the names of the people that I helped and whether I fixed them. Perhaps, I was naïve in believing that she would remain oblivious to these realities.