Stories from the World of Medicine

Season

4

Episode

6

|

Feb 1, 2022

The Ride

Pediatrician Christina Lee recounts a memorable ambulance ride from residency, in which she helped transport a child from the hospital to hospice.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

Stories from the World of Medicine

Season

4

Episode

6

|

Feb 1, 2022

The Ride

Pediatrician Christina Lee recounts a memorable ambulance ride from residency, in which she helped transport a child from the hospital to hospice.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

Stories from the World of Medicine

Season

4

Episode

6

|

2/1/22

The Ride

Pediatrician Christina Lee recounts a memorable ambulance ride from residency, in which she helped transport a child from the hospital to hospice.

0:00/1:34

Illustrations: Ashley Floréal

Illustration by Ashley Floréal

About Our Guest

Christina Lee is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley and her medical degree from New York Medical College. She completed her pediatric residency at Children’s Hospital Oakland and has worked as an urgent care pediatrician at Palo Alto Medical Foundation ever since. She lives in San Jose with her husband and two children.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Christina Lee is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley and her medical degree from New York Medical College. She completed her pediatric residency at Children’s Hospital Oakland and has worked as an urgent care pediatrician at Palo Alto Medical Foundation ever since. She lives in San Jose with her husband and two children.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

About Our Guest

Christina Lee is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley and her medical degree from New York Medical College. She completed her pediatric residency at Children’s Hospital Oakland and has worked as an urgent care pediatrician at Palo Alto Medical Foundation ever since. She lives in San Jose with her husband and two children.

About The Show

The Nocturnists is an award-winning medical storytelling podcast, hosted by physician Emily Silverman. We feature personal stories from frontline clinicians, conversations with healthcare-related authors, and art-makers. Our mission is to humanize healthcare and foster joy, wonder, and curiosity among clinicians and patients alike.

resources

Credits

The Nocturnists is made possible by the California Medical Association and people like you who have donated through our website and Patreon page. This episode of The Nocturnists is sponsored by Chartnote.

Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Christina Lee. Christina is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley, her medical degree from New York Medical College and completed her pediatric residency at Children's Hospital Oakland. Ever since training, she's worked as an urgent care pediatrician at Palo Alto Medical Foundation. She lives in San Jose with her husband and two children. Before we speak with Christina, we'll hear the story she told at The Nocturnists in January 2020 about her experience working "transport call" during her residency. Here's Christina.

Christina Lee

Racing across the Bay Bridge in an ambulance with lights flashing and sirens wailing was not how I imagined my nights off in residency, but that's where I found myself once while on transport call. I transported a lot of things in residency. Sometimes specimens to the lab, especially the ever so coveted champagne tab, which is a perfect crystal clear specimen of spinal fluid from a perfectly executed spinal tap. Or sometimes I transport X-rays. Yeah, back in the day, some patients had physical X-ray films, the kind you have to hold up to a light to see. Well, they would inevitably get lost, so I would hold them in my arms and deliver them directly to the radiologist.But the most important thing I transported were patients.In my residency, we did something called transport call, which meant if a patient from an outside hospital was really sick and needed specialized pediatric care and an intensive care unit, they would get transferred to our hospital and our transport team would go pick them up in an ambulance. The team consisted of two paramedics, a nurse, a respiratory therapist, or RT for short, and a doctor.Now sometimes we drive just 15 minutes away to a partner hospital. But sometimes we drove over an hour to a small community hospital with limited resources. They were expecting this specialized pediatric team. But little did they know they were getting me, a second year resident who really didn't know anything about medicine. Plus, there was the added stress of having to be ready at a moment's notice. Once I got the page, I had 30 minutes to get to the hospital. And the pages never came at a convenient time. Once I was in IKEA, and my pager went off, and I was in the showroom, and I couldn't find those shortcut exits. So I was stuck in this maze of Scandinavian furniture going around and around seeing the same fake living room over and over again, and getting bad flashbacks of having to assemble furniture by myself at two in the morning.But as with everything in residency, I soon got used to the unpredictability of transport call. So for a couple weeks at a time, a few times a year, I was ready. I could go from regular person to transporter at a moment's notice. I had my clipboard ready to go and a cheat sheet of common medications and ventilator settings. And after a while, it was kind of fun. We were the rescue squad here to save the day. We would each get our individual pages and arrive in the ICU and hear about the patient. Then we would gather any medications or supplies we might need, load up the ambulance and be on our way.The paramedics would sit in front and they were the navigators. They knew all the secret backroads and secret hospital entrances. I was in the back with the nurse in the RT in this 12 by 8 foot space. And there was one tiny window on the side so most of the back was lit with fluorescent lights. The ride was always bumpy and noisy with equipment clanging around, and the nurse and the RT would tell me all their crazy stories. Like the time they were stuck in rush hour traffic and had to do CPR on a patient, or the time the ambulance went over a huge pothole and the patient's breathing tube went out of place.Thankfully, though, most transports were smooth and the patients were stable. We might have a baby with a known congenital heart defect who was being transported for surgery, or a kid who had complex medical issues, but just had routine pneumonia. And probably the most common premature babies who just needed to feed and grow before going home with their parents. Our little entourage would arrive at the hospital and the nurse and the RT would descend upon the patient and do all the real work. Most patients were on a paralytic, a pain medication, a sedative and some IV fluids. So the nurse would get all the medications and IV lines in order, and then the RT would set up the ventilator. I would talk to the parents, get them to sign some paperwork, and then call our supervising doctor back at our hospital and give an update. And the parents usually followed behind us in their own car.Then I got called to one transport that I will never forget.From the beginning, I knew this one would be different when they told me the patient was already at our hospital. Tyler was a 10-year-old girl and she had battled cancer for years. And after spending several weeks in our ICU, she was in a coma and multi organ failure with no chance of survival. I was transporting Tyler to George Mark Children's House which is a Pediatric Palliative Care Center, and there she was going to be taken off life support.I went into the ICU and was surrounded by bright lights. There were faint traces of bleach mixed with stale coffee in the air. There was a usual swirl of constant activity and beeping alarms. I went into Tyler's room and it was dimly lit and somber. Various family members were standing around, some holding each other, some standing alone, and everyone was crying. I awkwardly introduced myself to her parents and retreated to the corner, feeling like an intruder. I watched as the RT set up the ventilator, the nurse hung the IV bag, and Tyler just lay there motionless, except for the gentle rise of her chest with every mechanical breath. The paramedics slowly moved her to the gurney and I followed behind as they wheeled her to the ambulance. I had no orders to write. The ventilator didn't need changing. There was just one sedative that dripped from her IV.We got in the ambulance, got on the freeway, and rode in complete silence. Tyler's mom was in the front and I was in the back with the nurse and the RT. All the alarms were off and we listened to the sound of the ventilator and the traffic. Looking back now, it seems wrong to me that I was next to Tyler and not her mom. Being a mother myself now, I wonder, shouldn't she have been there instead? Holding her hand or stroking her hair. Wouldn't she have wanted to spend every possible second of her daughter's last moments by her side. Well, as I sat next to Tyler, I wondered what she was like. Was she a quiet kid or an energetic one? Did she like climbing trees or reading books?She had the same color hair as Britney. Britney was a 17 year old girl I met on my first day of my oncology rotation. And she was chatty and friendly, though. she looked so scared. I introduced myself to her and tried to explain what an intern was. And she went, "Oh, I know! I watch Grey's Anatomy!"Or maybe she was wise beyond her years like Adam. Adam was a six year old and he had cancer for more than half his life. And he was a little too comfortable in the hospital. He would always warn me, "Don't pee in the hat on my toilet. The nurses have to measure how much I pee every day." And I'd say, "Adam, don't worry, I will not pee in your toilet. Residents don't have time to pee anyway."Or maybe she would get exasperated like Justin. Justin was the most adorable three year old and he had pancreatitis, so he couldn't eat. But every day he would ask us if that was the day that he could eat. And when we said no, he would throw his hands up in a hufff and say, "But I just want to eat chicken!" And when he finally got to eat something, he was munching on a doughnut. I know, not the healthiest choice, but he was dying of cancer. So he was eating this doughnut in the dark, and I turn the lights on, and he yells, "Turn the lights off, you're going to melt the doughnut." So of course, I turn the lights off and let him eat his use doughnut in the dark.Although I didn't know Tyler personally, I can imagine she knew a bit of what all these children had experienced. I bet she was wise beyond her years, the way so many of them were. Resilient and strong, and enduring the unimaginable. And sneaking in doughnuts whenever possible.We got off the freeway and drove through green rolling hills. We drove up the driveway to George Mark, what looked and felt like a real home. We drove around to a side entrance and the paramedics turn the ambulance around and backed in. They open the double doors, pulled out the ramp and carefully wheeled Tyler out of the ambulance and into the house. We walked through a short hallway that was warm with soft light and into this open and inviting room. The paramedics gently move Tyler to the bed, and her parents tucked her in with her own soft fluffy bedspread from home. Her loved ones gathered around her and we left so they could say their goodbyes. We went outside and the paramedics leaned against the ambulance. I sat on some steps with the nurse and the RT. And we gazed at the sky.We waited in silence for 30 minutes, maybe an hour. I don't really remember. Time stood still. When Tyler's parents were ready, we went back inside, turned off the ventilator, took out her breathing tube, and we left. As we drove back to the hospital, I looked out the window. It had been a gloomy, cloudy day. But just as the sun was setting, the clouds cleared, and the sky grew bright with color.

Emily Silverman

So I am sitting here with Christina Lee. Christina, thanks so much for coming in to chat with me.

Christina Lee

Thanks so much for having me.

Emily Silverman

So we last saw each other in January 2020 at the live show. This was all pre COVID. So tell me how you have been since then? Since, obviously, a lot has happened in the world.

Christina Lee

Oh my gosh, that's a huge question. It's been crazy and difficult and a roller coaster for sure. But emerging from that now and kind of starting to see a glimmer of possibility of some sort of normalcy has been helpful. But there were some dark times, it was really hard.

Emily Silverman

Talk about the night of storytelling and what that was like for you.

Christina Lee

That night was so much fun, like really one of the most special nights that I can remember. And I think it was just this sense of community in that room. It was a huge auditorium, but it really felt intimate. And I remember actually standing there during my story, and I could still see the audience a little bit, it wasn't totally blacked out. And I remember just like a couple right kind of front and center, and they were just like smiling and laughing. And it just felt really warm and really welcoming. And I really just felt honored actually to be on that stage with the other storytellers. Everyone's story was just so different, yet so interesting and meaningful and everyone was so supportive. I remember every time someone came back from telling their story, we would stand up and give him a standing ovation in the green room. It was really fun.

Emily Silverman

So in this story, you talk about taking transport call during residency, and you paint a pretty vivid picture of what that was like. Now that you're out of residency, do those memories feel far away? What is your perspective on that time?

Christina Lee

That was well over 10 years ago, and the memories are actually still pretty vivid. I think part of it was that I journaled a lot during that time just to help me process everything and I had a little blog. Google had blogs. And writing down in the moment helped cement that into my memory. And so I think back at those times, and it doesn't feel that long ago.

Emily Silverman

And remind me, the transport call responsibility, was that once a week, or was it a week block, or was it a month block? Or how much time were you actually spending in that role during residency?

Christina Lee

It would be for two weeks at a time. When usually if we were on like an easy elective that didn't have call, then we would be put on transport call. So maybe two weeks at a time, a few times a year, but you could also moonlight and take transport call. And so I guess in those shifts where it wasn't filled, you could sign up and you would get paid a certain amount just to be on call. And if you actually went on a transport, you'd get paid a lot more. So there were some residents that were really into it and would take call all the time.

Emily Silverman

You mentioned that you're working in urgent care pediatrics right now. Tell us about that. What's that like?

Christina Lee

Urgent care is really fun. I think I was drawn to it just because every day is completely unpredictable. I like that unpredictability. I like the variety. It can be really fast paced, but it can be really mundane sometimes too. It's a lot of fevers and colds and minor injuries. But it's still really fun. And I love to interact with the patients and the families.

Emily Silverman

How did you land in urgent care?

Christina Lee

Well, I actually wanted to be a hospitalist when I first started outside of residency, and I got a bunch of moonlighting jobs, and I also got an urgent care job just because I needed some more hours. And in residency, our urgent care was actually attached to the emergency department. And so it was really like the simplest of simplest things. And I didn't actually enjoy it that much, but when I started working out in the real world, in urgent cares, we actually saw higher acuity. And a lot of patients I learned just avoid the emergency room at all costs. And so we would get febrile seizures and anaphylaxis, and really bad asthma and bad fractures. So it was kind of this combination of ED and urgent care, but without like gunshot wounds, and like real trauma and real emergencies, because that's a little too intense for me. So I liked that kind of hybrid. And I also never was that interested in just general pediatrics, I kind of like some sort of pathology a little bit more. And so it was a little too much of, not that it's not important at all, of course, but just like normal development and behavioral issues, and a lot of it is actually parenting, which isn't really medicine. So I always kind of skewed more towards illnesses and injuries.

Emily Silverman

In pediatrics, we hear a lot about how, yes, you're taking care of the child, the patient, but in some ways you're almost taking care of the parents more. And that you're dealing with families and the family unit. How does that show up in the urgent care?

Christina Lee

That is my daily life. 100% it's almost always more that you are calming fears and anxieties in the parent, especially in the younger kids who are totally fine a lot of the time. I mean, they do have something, they have a fever, they have a cough, but the kid's as had pneumonia, she's in the hospital, could he have pneumonia? What happy as can be. But the parent is so worried about "my grandmother does that mean?" Or "I have friends who have babies who are in the hospital with RSV right now," and the baby is sitting there smiling totally fine, not a sniffle or a cough, but that's their worry. And so I feel like most of my job is actually explaining to parents, reassuring them. Figuring out what their actual concern is—what that fear or anxiety is behind what seems like a simple cold or a fever.

Emily Silverman

Is locating the patient's fear something that you feel like you were taught in medical school and residency, or is that something you learned along the way? And how do you do that work when you have a full list of patients to see?

Christina Lee

Yeah, that's definitely nothing I learned in residency or medical school and something I have just been learning and am still learning as I practice medicine. I think in the beginning, I was really just focused on the chief complaint and what's the diagnosis and what's the treatment, but I've learned over the years that that focus is not helpful to the parents. And it is such a challenge because we get 15 minute blocks. And we're often just packed one ride after another. Every 15 minutes, you're meeting a new patient, a whole new family. And I think the hardest challenge in urgent care is that most of these patients we've never met before. And so it's not like you have that relationship of years of trust built with their pediatrician, you're just this new person. And sometimes there are patients we see over and over again, and you do kind of build a relationship, but often you, you need to establish that trust in like five minutes, and then have them be able to trust you with their child's health and their care. And so it's really tricky. One thing I've started just doing is after kind of them listing off the symptoms, and everything else, I just say, "Is there anything else that's worrying you or that you're concerned about today?" just to kind of get at a deeper thing, or sometimes the patients will offer it and instead of just passing by over a mark they made of like, "We're so stressed right now, and my mom's in the hospital" and blah, blah, blah, but then kind of like taking that little hint of like, "Oh, I'm so sorry to hear that," and then you uncover the real concern. Or just at least understanding more of where they're coming from, what stress has been going on that day or in their lives at that moment. And just the acknowledgement of that often is enough to build that little bridge that you need to connect.

Emily Silverman

So how many patients do you see in a day, roughly?

Christina Lee

It depends on the shift. But we are pretty much booked every 15 minutes, and I'll work seven to nine hour shifts. And there's some breaks in between. So maybe 20-25 patients a day.

Emily Silverman

It's a lot. I mean, I know to any community doctors listening that probably sounds normal. But in academic medicine, the censuses are usually smaller than that. And so that sounds like a lot. Do you find yourself coming away from those workdays energized or drained? Or it depends on the day? Or how do you keep up your stamina?

Christina Lee

It definitely depends on the day. The Delta wave, it hit us hard. And my whole department has been super burnt out. And a lot of compassion fatigue. And so one not so great patient encounter will just color the whole rest of the day. And it's hard to keep up that pace when you're kind of under that shadow. So I started to do a reset, like one day started off really terribly. Just within the first hour, I was a half an hour behind. I had two really difficult parents and a medical assistant was like, "It's gonna be a day." And I was like, "We're gonna reset, I'm pressing the reset button right now. Ding. And we're gonna start all over." And then the next patient was lovely. And I think it's just reframing because ultimately, there's only a couple difficult patients, if any, each day, but most are just really lovely and sweet families and sweet kids. And just trying to focus on those encounters, that's what gives me energy. I mean, kids are fun. A lot of times they're quick, easy visits, and you can just talk about dinosaurs and trucks, and it's really fun. And I think focusing on that is what sustains me through the day.

Emily Silverman

You mentioned that COVID has been causing a lot of burnout where you are. Has it been having to do with attitudes among families around the vaccine? Or just the pure volume and the stress of the vaccine not being available to kids?

Christina Lee

I don't think it's hesitancy against vaccines. I work in an area that's highly vaccinated, and so that's not a huge issue for us. It was definitely the volume. It was tricky because we had for most of 2020 separated all patients into respiratory care clinics. And then in our urgent care, we didn't see those patients, but we started bringing those patients in once Delta hit and all the kids were back in their activities and everything. It was just this flood of patients and mainly a lot of them just needing tests. Some of them actually worried about their kids having COVID. And so it was this combination of sometimes a lot of anxiety from parents and trying to calm that down. And this balance of yes, COVID is something we take really seriously. And at the same time, your child's probably going to be okay even if it is COVID. So I didn't want to not give it the weight that it deserves, but in reality, most of the COVID cases we were seeing were really simple and the kids were fine. So balancing those anxieties. A lot of demanding parents who just want to test because they need to get back to their lives and they need to get their negative test. Just fielding all of that was really hard and just draining.

Emily Silverman

Yeah, I don't have kids myself, although I am expecting. But a lot of my friends do have kids, and it just sounds like as soon as there's an exposure in the classroom, everything falls apart. Or as soon as one kid gets a respiratory illness, whether it's COVID or not, it's like the other kids suddenly like can't go to daycare.

Christina Lee

It's like one domino falls and then the whole thing falls.

Emily Silverman

Totally, which I imagine might be driving some of this, like, I just need a test, I just need my negative test. And so I imagine that must have placed a huge burden on urgent care pediatrics, just trying to shuttle through even just the negative tests alone so that people can get back to their lives. Is that something that fell on your shoulders as a physician, or were there systems set up to handle that influx of need?

Christina Lee

There were some systems, but it was kind of convoluted and very confusing for the patients because it always kept changing. Initially, patients couldn't even come in, and so they would have to do a video visit. And then we would order a test. And then they would go to a test only site and then get their test. But then we started doing the test ourselves. And so patients figure that out. And then they just wanted to come in and we had a rapid test. And then everyone wanted the rapid test, because you could get those results back in an hour and they could go on with their lives. But then we realized we were just becoming this testing center of patients who really not worried about their kids cold at all, but just needed a test. So then we kind of changed that. And we weren't doing the rapid test anymore. Patients can now just schedule the test themselves online, but they don't even realize that they can do that. Because everything keeps changing, it's hard for even us to keep track, but then for the patients to keep track as well. So there are systems in place, but it's not streamlined and it's not easy to communicate.

Emily Silverman

I want to come back to your story because it's such a beautiful story. And you talk about how there was this cowboy feel bumping along the road and the ambulance. And then you focus in on this quiet ambulance ride with the dying girl and her mother. And as you're riding in the ambulance, you're looking at this patient, and then suddenly, you're remembering Brittany, and you're remembering Adam, and you're remembering all these patients from your training. Was there something about the patient that really made you take stock? Bring us into that moment in the ambulance, and why that small moment felt bigger to you, and why you chose that to submit to The Nocturnists.

Christina Lee

Often in residency, there were patients that we all knew who were always in the hospital, who practically lived in the hospital. And so we would hear of different developments in their care or if one of them passed. But this patient I never had even heard her name. I didn't know anything about her. And I kind of wondered what her story was. And so I kind of reflect back on all the other patients that I had met in a similar situation of having cancer and eventually dying. I think all those patients I mentioned in my story eventually did pass away. I would have dreams. And I remember one patient in particular that I just fell in love with. He was the sweetest four year old boy. And after my rotation for months afterwards, I would have dreams where I was just bawling and bawling. And I'd wake up and my pillowcase was covered in tears. And I think those kids just really warmed their way into my heart. The only life they knew was being in the hospital and being sick. It was just heartbreaking, but also I felt really privileged to witness and just be part of their story.

Emily Silverman

As you walk us through all of these different patients in your memory, there's quite a bit of humor that comes up. The one that comes to mind is the boy who was eating the doughnut and you turn on the lights and he said, "Don't turn on the lights the doughnut will melt" or something like that. Having worked this rotation in pediatric oncology and working with kids who are extremely sick, in some cases terminally sick, do you think that kids cope with that differently than adults? And if so, how?

Christina Lee

I do think kids cope differently. I think as a child, you are always told what to do. You have very little control over life. And so you just kind of accept what the grown ups say is going to happen. And same thing goes if you get sick, and so it's almost like not routine, but you're going into the hospital, you're going to get this port placed under your skin. And they're like, "Okay, I guess that's what Mommy says I have to do." And so I guess there's an acceptance that happens with kids, and maybe not even realizing how completely abnormal their life is, because that's the only life they know. And so I think there's less of that anger or need for control, or comparison to what their life was like for adults, or even like older adolescents, I would say is a lot different than the really young kids.

Emily Silverman

Were you interested in storytelling in medicine, before your performance at The Nocturnists?

Christina Lee

I only started thinking about storytelling in medicine after hearing The Nocturnists. I learned about it from a colleague, and I tuned into the podcast, and I was hooked. And every story, even if it was a completely different type of medicine, there were moments where I just connected and I felt like "Oh, they get it. That's what I felt, or that's what I experienced." And I think that was really, almost healing for me. I think a lot of those stories I held on to from residency and didn't have anything to do with them, but they obviously affected me and shaped who I am. And so to know that other people grappled with similar experiences, or had stories that they held on to helped with the process of healing from a lot of that sadness and that grief. Now, with COVID, hearing all those stories as well, especially at a time when life felt so isolating, just to hear the different ways people were experiencing that in their lives was also a way to kind of connect and be in community.

Emily Silverman

Hearing you talk about the parents that you deal with in your practice, while also being on the journey to becoming a parent myself. God willing, I'll have a healthy baby girl. My first. Our first, my husband and I. And I really don't know how I'm going to respond to the existence of this new person. Like, I don't know if I'm going to be one of those physician parents who is like, "Oh, you're bleeding, it's no big deal. I've seen worse." Or if I'm going to be maybe more anxious. And I'm not even a pediatrician, I take care of adults. And at times, I feel really grateful actually, that I forgot a lot of my pediatric medicine because it just gives me less to fixate on and worry about. So I guess my question is, what is it like being a pediatrician and a parent? How do you toggle between those roles? And then what advice do you have for a new parent like me?

Christina Lee

So much of parenting is not pediatrics. I remember when we first had my son, my husband was just like, "Well, just whatever you say, I'll just do that." But I was like, "I haven't done this, either. Like, I don't know anything about breastfeeding or like bathing a baby. I've seen the nurses do it, but I don't sit there and bathe babies, or like even diaper changing." So much of it has nothing to do with what I learned in residency, or med school at all. I think it helps in that I've seen how bad it can get and so I know when there's really nothing to worry about. Ultimately, you are not your child's doctor. So really trying to delineate that, like you are the parent, you have a lot of roles to play in this child's life. But diagnosing their illnesses and their potential learning issues, that is not your job. And so to find a pediatrician you really love and trust, that's probably the biggest help.

Emily Silverman

You've mentioned a couple times during this conversation that a lot of what it means to have a child—things like breastfeeding, bathing, developmental milestones, behavior, learning—that these aren't really things that we focus on in medical school or pediatrics residency, that it's much more disease focused. I know that you said your preference is actually more diseases and pathology, but do you think we need to be incorporating some of this other stuff into our medical education? Like should we be more knowledgeable about breastfeeding as a profession? Should we be more knowledgeable about parenting philosophies? Or is it best left to the psychologists and all those parenting books and other disciplines?

Christina Lee

I think we absolutely need to. And all the pediatricians I know now have just learned that outside of residency in their practice, because parents go to their pediatrician for all of that. And they expect them to know about how to handle tantrums and picky eating, and all these things that I remember getting like maybe one lecture in residency about. 30 minutes about what to do with a picky eater, which is totally insufficient. And so so much of that is just learned on the job, and also just being a parent themselves I think. It's hard because there's so much to learn in residency, but especially those going into general pediatrics. It is so much of what parents come to pediatricians for.

Emily Silverman

I was talking to a friend the other day, and she's a pediatrician. And she just had a kid a year or two ago, and she said that it totally transformed her approach to her patients. And so I'm wondering, when you had your kids did that happen?

Christina Lee

Definitely, I think having kids made me a better pediatrician. And not to say that, I know plenty of pediatricians who have no children who are wonderful. But I think for me, in particular, it was always hard for me to connect with the crazy fatigue and a complete overwhelming experience of having a newborn. I just didn't get it. And so these parents would come in for like their bilirubin checks. And I would just do the things and check their bilirubin and your baby's fine. But now those are my favorite visits, because I just remember that time, and I just feel for those poor, exhausted parents. And you can just see the complete sense of being totally overwhelmed in their eyes and totally sleep deprived. And I just love those visits because I remember what it's like, and I love to just be there with them in that and just say, "You're doing a great job. Your baby looks great. It's gonna be okay." It's really fun.

Emily Silverman

Even just hearing you say that in a hypothetical is calming me. Well, it's been so great talking to you, Christina. Thank you for coming in to chat with me today. Thank you for telling that beautiful story on stage at The Nocturnists and for continuing to listen and for being a part of The Nocturnists family.

Christina Lee

Thank you for having me.

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Christina Lee. Christina is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley, her medical degree from New York Medical College and completed her pediatric residency at Children's Hospital Oakland. Ever since training, she's worked as an urgent care pediatrician at Palo Alto Medical Foundation. She lives in San Jose with her husband and two children. Before we speak with Christina, we'll hear the story she told at The Nocturnists in January 2020 about her experience working "transport call" during her residency. Here's Christina.

Christina Lee

Racing across the Bay Bridge in an ambulance with lights flashing and sirens wailing was not how I imagined my nights off in residency, but that's where I found myself once while on transport call. I transported a lot of things in residency. Sometimes specimens to the lab, especially the ever so coveted champagne tab, which is a perfect crystal clear specimen of spinal fluid from a perfectly executed spinal tap. Or sometimes I transport X-rays. Yeah, back in the day, some patients had physical X-ray films, the kind you have to hold up to a light to see. Well, they would inevitably get lost, so I would hold them in my arms and deliver them directly to the radiologist.But the most important thing I transported were patients.In my residency, we did something called transport call, which meant if a patient from an outside hospital was really sick and needed specialized pediatric care and an intensive care unit, they would get transferred to our hospital and our transport team would go pick them up in an ambulance. The team consisted of two paramedics, a nurse, a respiratory therapist, or RT for short, and a doctor.Now sometimes we drive just 15 minutes away to a partner hospital. But sometimes we drove over an hour to a small community hospital with limited resources. They were expecting this specialized pediatric team. But little did they know they were getting me, a second year resident who really didn't know anything about medicine. Plus, there was the added stress of having to be ready at a moment's notice. Once I got the page, I had 30 minutes to get to the hospital. And the pages never came at a convenient time. Once I was in IKEA, and my pager went off, and I was in the showroom, and I couldn't find those shortcut exits. So I was stuck in this maze of Scandinavian furniture going around and around seeing the same fake living room over and over again, and getting bad flashbacks of having to assemble furniture by myself at two in the morning.But as with everything in residency, I soon got used to the unpredictability of transport call. So for a couple weeks at a time, a few times a year, I was ready. I could go from regular person to transporter at a moment's notice. I had my clipboard ready to go and a cheat sheet of common medications and ventilator settings. And after a while, it was kind of fun. We were the rescue squad here to save the day. We would each get our individual pages and arrive in the ICU and hear about the patient. Then we would gather any medications or supplies we might need, load up the ambulance and be on our way.The paramedics would sit in front and they were the navigators. They knew all the secret backroads and secret hospital entrances. I was in the back with the nurse in the RT in this 12 by 8 foot space. And there was one tiny window on the side so most of the back was lit with fluorescent lights. The ride was always bumpy and noisy with equipment clanging around, and the nurse and the RT would tell me all their crazy stories. Like the time they were stuck in rush hour traffic and had to do CPR on a patient, or the time the ambulance went over a huge pothole and the patient's breathing tube went out of place.Thankfully, though, most transports were smooth and the patients were stable. We might have a baby with a known congenital heart defect who was being transported for surgery, or a kid who had complex medical issues, but just had routine pneumonia. And probably the most common premature babies who just needed to feed and grow before going home with their parents. Our little entourage would arrive at the hospital and the nurse and the RT would descend upon the patient and do all the real work. Most patients were on a paralytic, a pain medication, a sedative and some IV fluids. So the nurse would get all the medications and IV lines in order, and then the RT would set up the ventilator. I would talk to the parents, get them to sign some paperwork, and then call our supervising doctor back at our hospital and give an update. And the parents usually followed behind us in their own car.Then I got called to one transport that I will never forget.From the beginning, I knew this one would be different when they told me the patient was already at our hospital. Tyler was a 10-year-old girl and she had battled cancer for years. And after spending several weeks in our ICU, she was in a coma and multi organ failure with no chance of survival. I was transporting Tyler to George Mark Children's House which is a Pediatric Palliative Care Center, and there she was going to be taken off life support.I went into the ICU and was surrounded by bright lights. There were faint traces of bleach mixed with stale coffee in the air. There was a usual swirl of constant activity and beeping alarms. I went into Tyler's room and it was dimly lit and somber. Various family members were standing around, some holding each other, some standing alone, and everyone was crying. I awkwardly introduced myself to her parents and retreated to the corner, feeling like an intruder. I watched as the RT set up the ventilator, the nurse hung the IV bag, and Tyler just lay there motionless, except for the gentle rise of her chest with every mechanical breath. The paramedics slowly moved her to the gurney and I followed behind as they wheeled her to the ambulance. I had no orders to write. The ventilator didn't need changing. There was just one sedative that dripped from her IV.We got in the ambulance, got on the freeway, and rode in complete silence. Tyler's mom was in the front and I was in the back with the nurse and the RT. All the alarms were off and we listened to the sound of the ventilator and the traffic. Looking back now, it seems wrong to me that I was next to Tyler and not her mom. Being a mother myself now, I wonder, shouldn't she have been there instead? Holding her hand or stroking her hair. Wouldn't she have wanted to spend every possible second of her daughter's last moments by her side. Well, as I sat next to Tyler, I wondered what she was like. Was she a quiet kid or an energetic one? Did she like climbing trees or reading books?She had the same color hair as Britney. Britney was a 17 year old girl I met on my first day of my oncology rotation. And she was chatty and friendly, though. she looked so scared. I introduced myself to her and tried to explain what an intern was. And she went, "Oh, I know! I watch Grey's Anatomy!"Or maybe she was wise beyond her years like Adam. Adam was a six year old and he had cancer for more than half his life. And he was a little too comfortable in the hospital. He would always warn me, "Don't pee in the hat on my toilet. The nurses have to measure how much I pee every day." And I'd say, "Adam, don't worry, I will not pee in your toilet. Residents don't have time to pee anyway."Or maybe she would get exasperated like Justin. Justin was the most adorable three year old and he had pancreatitis, so he couldn't eat. But every day he would ask us if that was the day that he could eat. And when we said no, he would throw his hands up in a hufff and say, "But I just want to eat chicken!" And when he finally got to eat something, he was munching on a doughnut. I know, not the healthiest choice, but he was dying of cancer. So he was eating this doughnut in the dark, and I turn the lights on, and he yells, "Turn the lights off, you're going to melt the doughnut." So of course, I turn the lights off and let him eat his use doughnut in the dark.Although I didn't know Tyler personally, I can imagine she knew a bit of what all these children had experienced. I bet she was wise beyond her years, the way so many of them were. Resilient and strong, and enduring the unimaginable. And sneaking in doughnuts whenever possible.We got off the freeway and drove through green rolling hills. We drove up the driveway to George Mark, what looked and felt like a real home. We drove around to a side entrance and the paramedics turn the ambulance around and backed in. They open the double doors, pulled out the ramp and carefully wheeled Tyler out of the ambulance and into the house. We walked through a short hallway that was warm with soft light and into this open and inviting room. The paramedics gently move Tyler to the bed, and her parents tucked her in with her own soft fluffy bedspread from home. Her loved ones gathered around her and we left so they could say their goodbyes. We went outside and the paramedics leaned against the ambulance. I sat on some steps with the nurse and the RT. And we gazed at the sky.We waited in silence for 30 minutes, maybe an hour. I don't really remember. Time stood still. When Tyler's parents were ready, we went back inside, turned off the ventilator, took out her breathing tube, and we left. As we drove back to the hospital, I looked out the window. It had been a gloomy, cloudy day. But just as the sun was setting, the clouds cleared, and the sky grew bright with color.

Emily Silverman

So I am sitting here with Christina Lee. Christina, thanks so much for coming in to chat with me.

Christina Lee

Thanks so much for having me.

Emily Silverman

So we last saw each other in January 2020 at the live show. This was all pre COVID. So tell me how you have been since then? Since, obviously, a lot has happened in the world.

Christina Lee

Oh my gosh, that's a huge question. It's been crazy and difficult and a roller coaster for sure. But emerging from that now and kind of starting to see a glimmer of possibility of some sort of normalcy has been helpful. But there were some dark times, it was really hard.

Emily Silverman

Talk about the night of storytelling and what that was like for you.

Christina Lee

That night was so much fun, like really one of the most special nights that I can remember. And I think it was just this sense of community in that room. It was a huge auditorium, but it really felt intimate. And I remember actually standing there during my story, and I could still see the audience a little bit, it wasn't totally blacked out. And I remember just like a couple right kind of front and center, and they were just like smiling and laughing. And it just felt really warm and really welcoming. And I really just felt honored actually to be on that stage with the other storytellers. Everyone's story was just so different, yet so interesting and meaningful and everyone was so supportive. I remember every time someone came back from telling their story, we would stand up and give him a standing ovation in the green room. It was really fun.

Emily Silverman

So in this story, you talk about taking transport call during residency, and you paint a pretty vivid picture of what that was like. Now that you're out of residency, do those memories feel far away? What is your perspective on that time?

Christina Lee

That was well over 10 years ago, and the memories are actually still pretty vivid. I think part of it was that I journaled a lot during that time just to help me process everything and I had a little blog. Google had blogs. And writing down in the moment helped cement that into my memory. And so I think back at those times, and it doesn't feel that long ago.

Emily Silverman

And remind me, the transport call responsibility, was that once a week, or was it a week block, or was it a month block? Or how much time were you actually spending in that role during residency?

Christina Lee

It would be for two weeks at a time. When usually if we were on like an easy elective that didn't have call, then we would be put on transport call. So maybe two weeks at a time, a few times a year, but you could also moonlight and take transport call. And so I guess in those shifts where it wasn't filled, you could sign up and you would get paid a certain amount just to be on call. And if you actually went on a transport, you'd get paid a lot more. So there were some residents that were really into it and would take call all the time.

Emily Silverman

You mentioned that you're working in urgent care pediatrics right now. Tell us about that. What's that like?

Christina Lee

Urgent care is really fun. I think I was drawn to it just because every day is completely unpredictable. I like that unpredictability. I like the variety. It can be really fast paced, but it can be really mundane sometimes too. It's a lot of fevers and colds and minor injuries. But it's still really fun. And I love to interact with the patients and the families.

Emily Silverman

How did you land in urgent care?

Christina Lee

Well, I actually wanted to be a hospitalist when I first started outside of residency, and I got a bunch of moonlighting jobs, and I also got an urgent care job just because I needed some more hours. And in residency, our urgent care was actually attached to the emergency department. And so it was really like the simplest of simplest things. And I didn't actually enjoy it that much, but when I started working out in the real world, in urgent cares, we actually saw higher acuity. And a lot of patients I learned just avoid the emergency room at all costs. And so we would get febrile seizures and anaphylaxis, and really bad asthma and bad fractures. So it was kind of this combination of ED and urgent care, but without like gunshot wounds, and like real trauma and real emergencies, because that's a little too intense for me. So I liked that kind of hybrid. And I also never was that interested in just general pediatrics, I kind of like some sort of pathology a little bit more. And so it was a little too much of, not that it's not important at all, of course, but just like normal development and behavioral issues, and a lot of it is actually parenting, which isn't really medicine. So I always kind of skewed more towards illnesses and injuries.

Emily Silverman

In pediatrics, we hear a lot about how, yes, you're taking care of the child, the patient, but in some ways you're almost taking care of the parents more. And that you're dealing with families and the family unit. How does that show up in the urgent care?

Christina Lee

That is my daily life. 100% it's almost always more that you are calming fears and anxieties in the parent, especially in the younger kids who are totally fine a lot of the time. I mean, they do have something, they have a fever, they have a cough, but the kid's as had pneumonia, she's in the hospital, could he have pneumonia? What happy as can be. But the parent is so worried about "my grandmother does that mean?" Or "I have friends who have babies who are in the hospital with RSV right now," and the baby is sitting there smiling totally fine, not a sniffle or a cough, but that's their worry. And so I feel like most of my job is actually explaining to parents, reassuring them. Figuring out what their actual concern is—what that fear or anxiety is behind what seems like a simple cold or a fever.

Emily Silverman

Is locating the patient's fear something that you feel like you were taught in medical school and residency, or is that something you learned along the way? And how do you do that work when you have a full list of patients to see?

Christina Lee

Yeah, that's definitely nothing I learned in residency or medical school and something I have just been learning and am still learning as I practice medicine. I think in the beginning, I was really just focused on the chief complaint and what's the diagnosis and what's the treatment, but I've learned over the years that that focus is not helpful to the parents. And it is such a challenge because we get 15 minute blocks. And we're often just packed one ride after another. Every 15 minutes, you're meeting a new patient, a whole new family. And I think the hardest challenge in urgent care is that most of these patients we've never met before. And so it's not like you have that relationship of years of trust built with their pediatrician, you're just this new person. And sometimes there are patients we see over and over again, and you do kind of build a relationship, but often you, you need to establish that trust in like five minutes, and then have them be able to trust you with their child's health and their care. And so it's really tricky. One thing I've started just doing is after kind of them listing off the symptoms, and everything else, I just say, "Is there anything else that's worrying you or that you're concerned about today?" just to kind of get at a deeper thing, or sometimes the patients will offer it and instead of just passing by over a mark they made of like, "We're so stressed right now, and my mom's in the hospital" and blah, blah, blah, but then kind of like taking that little hint of like, "Oh, I'm so sorry to hear that," and then you uncover the real concern. Or just at least understanding more of where they're coming from, what stress has been going on that day or in their lives at that moment. And just the acknowledgement of that often is enough to build that little bridge that you need to connect.

Emily Silverman

So how many patients do you see in a day, roughly?

Christina Lee

It depends on the shift. But we are pretty much booked every 15 minutes, and I'll work seven to nine hour shifts. And there's some breaks in between. So maybe 20-25 patients a day.

Emily Silverman

It's a lot. I mean, I know to any community doctors listening that probably sounds normal. But in academic medicine, the censuses are usually smaller than that. And so that sounds like a lot. Do you find yourself coming away from those workdays energized or drained? Or it depends on the day? Or how do you keep up your stamina?

Christina Lee

It definitely depends on the day. The Delta wave, it hit us hard. And my whole department has been super burnt out. And a lot of compassion fatigue. And so one not so great patient encounter will just color the whole rest of the day. And it's hard to keep up that pace when you're kind of under that shadow. So I started to do a reset, like one day started off really terribly. Just within the first hour, I was a half an hour behind. I had two really difficult parents and a medical assistant was like, "It's gonna be a day." And I was like, "We're gonna reset, I'm pressing the reset button right now. Ding. And we're gonna start all over." And then the next patient was lovely. And I think it's just reframing because ultimately, there's only a couple difficult patients, if any, each day, but most are just really lovely and sweet families and sweet kids. And just trying to focus on those encounters, that's what gives me energy. I mean, kids are fun. A lot of times they're quick, easy visits, and you can just talk about dinosaurs and trucks, and it's really fun. And I think focusing on that is what sustains me through the day.

Emily Silverman

You mentioned that COVID has been causing a lot of burnout where you are. Has it been having to do with attitudes among families around the vaccine? Or just the pure volume and the stress of the vaccine not being available to kids?

Christina Lee

I don't think it's hesitancy against vaccines. I work in an area that's highly vaccinated, and so that's not a huge issue for us. It was definitely the volume. It was tricky because we had for most of 2020 separated all patients into respiratory care clinics. And then in our urgent care, we didn't see those patients, but we started bringing those patients in once Delta hit and all the kids were back in their activities and everything. It was just this flood of patients and mainly a lot of them just needing tests. Some of them actually worried about their kids having COVID. And so it was this combination of sometimes a lot of anxiety from parents and trying to calm that down. And this balance of yes, COVID is something we take really seriously. And at the same time, your child's probably going to be okay even if it is COVID. So I didn't want to not give it the weight that it deserves, but in reality, most of the COVID cases we were seeing were really simple and the kids were fine. So balancing those anxieties. A lot of demanding parents who just want to test because they need to get back to their lives and they need to get their negative test. Just fielding all of that was really hard and just draining.

Emily Silverman

Yeah, I don't have kids myself, although I am expecting. But a lot of my friends do have kids, and it just sounds like as soon as there's an exposure in the classroom, everything falls apart. Or as soon as one kid gets a respiratory illness, whether it's COVID or not, it's like the other kids suddenly like can't go to daycare.

Christina Lee

It's like one domino falls and then the whole thing falls.

Emily Silverman

Totally, which I imagine might be driving some of this, like, I just need a test, I just need my negative test. And so I imagine that must have placed a huge burden on urgent care pediatrics, just trying to shuttle through even just the negative tests alone so that people can get back to their lives. Is that something that fell on your shoulders as a physician, or were there systems set up to handle that influx of need?

Christina Lee

There were some systems, but it was kind of convoluted and very confusing for the patients because it always kept changing. Initially, patients couldn't even come in, and so they would have to do a video visit. And then we would order a test. And then they would go to a test only site and then get their test. But then we started doing the test ourselves. And so patients figure that out. And then they just wanted to come in and we had a rapid test. And then everyone wanted the rapid test, because you could get those results back in an hour and they could go on with their lives. But then we realized we were just becoming this testing center of patients who really not worried about their kids cold at all, but just needed a test. So then we kind of changed that. And we weren't doing the rapid test anymore. Patients can now just schedule the test themselves online, but they don't even realize that they can do that. Because everything keeps changing, it's hard for even us to keep track, but then for the patients to keep track as well. So there are systems in place, but it's not streamlined and it's not easy to communicate.

Emily Silverman

I want to come back to your story because it's such a beautiful story. And you talk about how there was this cowboy feel bumping along the road and the ambulance. And then you focus in on this quiet ambulance ride with the dying girl and her mother. And as you're riding in the ambulance, you're looking at this patient, and then suddenly, you're remembering Brittany, and you're remembering Adam, and you're remembering all these patients from your training. Was there something about the patient that really made you take stock? Bring us into that moment in the ambulance, and why that small moment felt bigger to you, and why you chose that to submit to The Nocturnists.

Christina Lee

Often in residency, there were patients that we all knew who were always in the hospital, who practically lived in the hospital. And so we would hear of different developments in their care or if one of them passed. But this patient I never had even heard her name. I didn't know anything about her. And I kind of wondered what her story was. And so I kind of reflect back on all the other patients that I had met in a similar situation of having cancer and eventually dying. I think all those patients I mentioned in my story eventually did pass away. I would have dreams. And I remember one patient in particular that I just fell in love with. He was the sweetest four year old boy. And after my rotation for months afterwards, I would have dreams where I was just bawling and bawling. And I'd wake up and my pillowcase was covered in tears. And I think those kids just really warmed their way into my heart. The only life they knew was being in the hospital and being sick. It was just heartbreaking, but also I felt really privileged to witness and just be part of their story.

Emily Silverman

As you walk us through all of these different patients in your memory, there's quite a bit of humor that comes up. The one that comes to mind is the boy who was eating the doughnut and you turn on the lights and he said, "Don't turn on the lights the doughnut will melt" or something like that. Having worked this rotation in pediatric oncology and working with kids who are extremely sick, in some cases terminally sick, do you think that kids cope with that differently than adults? And if so, how?

Christina Lee

I do think kids cope differently. I think as a child, you are always told what to do. You have very little control over life. And so you just kind of accept what the grown ups say is going to happen. And same thing goes if you get sick, and so it's almost like not routine, but you're going into the hospital, you're going to get this port placed under your skin. And they're like, "Okay, I guess that's what Mommy says I have to do." And so I guess there's an acceptance that happens with kids, and maybe not even realizing how completely abnormal their life is, because that's the only life they know. And so I think there's less of that anger or need for control, or comparison to what their life was like for adults, or even like older adolescents, I would say is a lot different than the really young kids.

Emily Silverman

Were you interested in storytelling in medicine, before your performance at The Nocturnists?

Christina Lee

I only started thinking about storytelling in medicine after hearing The Nocturnists. I learned about it from a colleague, and I tuned into the podcast, and I was hooked. And every story, even if it was a completely different type of medicine, there were moments where I just connected and I felt like "Oh, they get it. That's what I felt, or that's what I experienced." And I think that was really, almost healing for me. I think a lot of those stories I held on to from residency and didn't have anything to do with them, but they obviously affected me and shaped who I am. And so to know that other people grappled with similar experiences, or had stories that they held on to helped with the process of healing from a lot of that sadness and that grief. Now, with COVID, hearing all those stories as well, especially at a time when life felt so isolating, just to hear the different ways people were experiencing that in their lives was also a way to kind of connect and be in community.

Emily Silverman

Hearing you talk about the parents that you deal with in your practice, while also being on the journey to becoming a parent myself. God willing, I'll have a healthy baby girl. My first. Our first, my husband and I. And I really don't know how I'm going to respond to the existence of this new person. Like, I don't know if I'm going to be one of those physician parents who is like, "Oh, you're bleeding, it's no big deal. I've seen worse." Or if I'm going to be maybe more anxious. And I'm not even a pediatrician, I take care of adults. And at times, I feel really grateful actually, that I forgot a lot of my pediatric medicine because it just gives me less to fixate on and worry about. So I guess my question is, what is it like being a pediatrician and a parent? How do you toggle between those roles? And then what advice do you have for a new parent like me?

Christina Lee

So much of parenting is not pediatrics. I remember when we first had my son, my husband was just like, "Well, just whatever you say, I'll just do that." But I was like, "I haven't done this, either. Like, I don't know anything about breastfeeding or like bathing a baby. I've seen the nurses do it, but I don't sit there and bathe babies, or like even diaper changing." So much of it has nothing to do with what I learned in residency, or med school at all. I think it helps in that I've seen how bad it can get and so I know when there's really nothing to worry about. Ultimately, you are not your child's doctor. So really trying to delineate that, like you are the parent, you have a lot of roles to play in this child's life. But diagnosing their illnesses and their potential learning issues, that is not your job. And so to find a pediatrician you really love and trust, that's probably the biggest help.

Emily Silverman

You've mentioned a couple times during this conversation that a lot of what it means to have a child—things like breastfeeding, bathing, developmental milestones, behavior, learning—that these aren't really things that we focus on in medical school or pediatrics residency, that it's much more disease focused. I know that you said your preference is actually more diseases and pathology, but do you think we need to be incorporating some of this other stuff into our medical education? Like should we be more knowledgeable about breastfeeding as a profession? Should we be more knowledgeable about parenting philosophies? Or is it best left to the psychologists and all those parenting books and other disciplines?

Christina Lee

I think we absolutely need to. And all the pediatricians I know now have just learned that outside of residency in their practice, because parents go to their pediatrician for all of that. And they expect them to know about how to handle tantrums and picky eating, and all these things that I remember getting like maybe one lecture in residency about. 30 minutes about what to do with a picky eater, which is totally insufficient. And so so much of that is just learned on the job, and also just being a parent themselves I think. It's hard because there's so much to learn in residency, but especially those going into general pediatrics. It is so much of what parents come to pediatricians for.

Emily Silverman

I was talking to a friend the other day, and she's a pediatrician. And she just had a kid a year or two ago, and she said that it totally transformed her approach to her patients. And so I'm wondering, when you had your kids did that happen?

Christina Lee

Definitely, I think having kids made me a better pediatrician. And not to say that, I know plenty of pediatricians who have no children who are wonderful. But I think for me, in particular, it was always hard for me to connect with the crazy fatigue and a complete overwhelming experience of having a newborn. I just didn't get it. And so these parents would come in for like their bilirubin checks. And I would just do the things and check their bilirubin and your baby's fine. But now those are my favorite visits, because I just remember that time, and I just feel for those poor, exhausted parents. And you can just see the complete sense of being totally overwhelmed in their eyes and totally sleep deprived. And I just love those visits because I remember what it's like, and I love to just be there with them in that and just say, "You're doing a great job. Your baby looks great. It's gonna be okay." It's really fun.

Emily Silverman

Even just hearing you say that in a hypothetical is calming me. Well, it's been so great talking to you, Christina. Thank you for coming in to chat with me today. Thank you for telling that beautiful story on stage at The Nocturnists and for continuing to listen and for being a part of The Nocturnists family.

Christina Lee

Thank you for having me.

Transcript

Note: The Nocturnists is created primarily as a listening experience. The audio contains emotion, emphasis, and soundscapes that are not easily transcribed. We encourage you to listen to the episode if at all possible. Our transcripts are produced using both speech recognition software and human copy editors, and may not be 100% accurate. Thank you for consulting the audio before quoting in print.

Emily Silverman

This is The Nocturnists: Stories from the World of Medicine. I'm Emily Silverman. Today I speak with Christina Lee. Christina is an urgent care pediatrician in the San Francisco Bay Area. She received her BA from UC Berkeley, her medical degree from New York Medical College and completed her pediatric residency at Children's Hospital Oakland. Ever since training, she's worked as an urgent care pediatrician at Palo Alto Medical Foundation. She lives in San Jose with her husband and two children. Before we speak with Christina, we'll hear the story she told at The Nocturnists in January 2020 about her experience working "transport call" during her residency. Here's Christina.

Christina Lee

Racing across the Bay Bridge in an ambulance with lights flashing and sirens wailing was not how I imagined my nights off in residency, but that's where I found myself once while on transport call. I transported a lot of things in residency. Sometimes specimens to the lab, especially the ever so coveted champagne tab, which is a perfect crystal clear specimen of spinal fluid from a perfectly executed spinal tap. Or sometimes I transport X-rays. Yeah, back in the day, some patients had physical X-ray films, the kind you have to hold up to a light to see. Well, they would inevitably get lost, so I would hold them in my arms and deliver them directly to the radiologist.But the most important thing I transported were patients.In my residency, we did something called transport call, which meant if a patient from an outside hospital was really sick and needed specialized pediatric care and an intensive care unit, they would get transferred to our hospital and our transport team would go pick them up in an ambulance. The team consisted of two paramedics, a nurse, a respiratory therapist, or RT for short, and a doctor.Now sometimes we drive just 15 minutes away to a partner hospital. But sometimes we drove over an hour to a small community hospital with limited resources. They were expecting this specialized pediatric team. But little did they know they were getting me, a second year resident who really didn't know anything about medicine. Plus, there was the added stress of having to be ready at a moment's notice. Once I got the page, I had 30 minutes to get to the hospital. And the pages never came at a convenient time. Once I was in IKEA, and my pager went off, and I was in the showroom, and I couldn't find those shortcut exits. So I was stuck in this maze of Scandinavian furniture going around and around seeing the same fake living room over and over again, and getting bad flashbacks of having to assemble furniture by myself at two in the morning.But as with everything in residency, I soon got used to the unpredictability of transport call. So for a couple weeks at a time, a few times a year, I was ready. I could go from regular person to transporter at a moment's notice. I had my clipboard ready to go and a cheat sheet of common medications and ventilator settings. And after a while, it was kind of fun. We were the rescue squad here to save the day. We would each get our individual pages and arrive in the ICU and hear about the patient. Then we would gather any medications or supplies we might need, load up the ambulance and be on our way.The paramedics would sit in front and they were the navigators. They knew all the secret backroads and secret hospital entrances. I was in the back with the nurse in the RT in this 12 by 8 foot space. And there was one tiny window on the side so most of the back was lit with fluorescent lights. The ride was always bumpy and noisy with equipment clanging around, and the nurse and the RT would tell me all their crazy stories. Like the time they were stuck in rush hour traffic and had to do CPR on a patient, or the time the ambulance went over a huge pothole and the patient's breathing tube went out of place.Thankfully, though, most transports were smooth and the patients were stable. We might have a baby with a known congenital heart defect who was being transported for surgery, or a kid who had complex medical issues, but just had routine pneumonia. And probably the most common premature babies who just needed to feed and grow before going home with their parents. Our little entourage would arrive at the hospital and the nurse and the RT would descend upon the patient and do all the real work. Most patients were on a paralytic, a pain medication, a sedative and some IV fluids. So the nurse would get all the medications and IV lines in order, and then the RT would set up the ventilator. I would talk to the parents, get them to sign some paperwork, and then call our supervising doctor back at our hospital and give an update. And the parents usually followed behind us in their own car.Then I got called to one transport that I will never forget.From the beginning, I knew this one would be different when they told me the patient was already at our hospital. Tyler was a 10-year-old girl and she had battled cancer for years. And after spending several weeks in our ICU, she was in a coma and multi organ failure with no chance of survival. I was transporting Tyler to George Mark Children's House which is a Pediatric Palliative Care Center, and there she was going to be taken off life support.I went into the ICU and was surrounded by bright lights. There were faint traces of bleach mixed with stale coffee in the air. There was a usual swirl of constant activity and beeping alarms. I went into Tyler's room and it was dimly lit and somber. Various family members were standing around, some holding each other, some standing alone, and everyone was crying. I awkwardly introduced myself to her parents and retreated to the corner, feeling like an intruder. I watched as the RT set up the ventilator, the nurse hung the IV bag, and Tyler just lay there motionless, except for the gentle rise of her chest with every mechanical breath. The paramedics slowly moved her to the gurney and I followed behind as they wheeled her to the ambulance. I had no orders to write. The ventilator didn't need changing. There was just one sedative that dripped from her IV.We got in the ambulance, got on the freeway, and rode in complete silence. Tyler's mom was in the front and I was in the back with the nurse and the RT. All the alarms were off and we listened to the sound of the ventilator and the traffic. Looking back now, it seems wrong to me that I was next to Tyler and not her mom. Being a mother myself now, I wonder, shouldn't she have been there instead? Holding her hand or stroking her hair. Wouldn't she have wanted to spend every possible second of her daughter's last moments by her side. Well, as I sat next to Tyler, I wondered what she was like. Was she a quiet kid or an energetic one? Did she like climbing trees or reading books?She had the same color hair as Britney. Britney was a 17 year old girl I met on my first day of my oncology rotation. And she was chatty and friendly, though. she looked so scared. I introduced myself to her and tried to explain what an intern was. And she went, "Oh, I know! I watch Grey's Anatomy!"Or maybe she was wise beyond her years like Adam. Adam was a six year old and he had cancer for more than half his life. And he was a little too comfortable in the hospital. He would always warn me, "Don't pee in the hat on my toilet. The nurses have to measure how much I pee every day." And I'd say, "Adam, don't worry, I will not pee in your toilet. Residents don't have time to pee anyway."Or maybe she would get exasperated like Justin. Justin was the most adorable three year old and he had pancreatitis, so he couldn't eat. But every day he would ask us if that was the day that he could eat. And when we said no, he would throw his hands up in a hufff and say, "But I just want to eat chicken!" And when he finally got to eat something, he was munching on a doughnut. I know, not the healthiest choice, but he was dying of cancer. So he was eating this doughnut in the dark, and I turn the lights on, and he yells, "Turn the lights off, you're going to melt the doughnut." So of course, I turn the lights off and let him eat his use doughnut in the dark.Although I didn't know Tyler personally, I can imagine she knew a bit of what all these children had experienced. I bet she was wise beyond her years, the way so many of them were. Resilient and strong, and enduring the unimaginable. And sneaking in doughnuts whenever possible.We got off the freeway and drove through green rolling hills. We drove up the driveway to George Mark, what looked and felt like a real home. We drove around to a side entrance and the paramedics turn the ambulance around and backed in. They open the double doors, pulled out the ramp and carefully wheeled Tyler out of the ambulance and into the house. We walked through a short hallway that was warm with soft light and into this open and inviting room. The paramedics gently move Tyler to the bed, and her parents tucked her in with her own soft fluffy bedspread from home. Her loved ones gathered around her and we left so they could say their goodbyes. We went outside and the paramedics leaned against the ambulance. I sat on some steps with the nurse and the RT. And we gazed at the sky.We waited in silence for 30 minutes, maybe an hour. I don't really remember. Time stood still. When Tyler's parents were ready, we went back inside, turned off the ventilator, took out her breathing tube, and we left. As we drove back to the hospital, I looked out the window. It had been a gloomy, cloudy day. But just as the sun was setting, the clouds cleared, and the sky grew bright with color.

Emily Silverman

So I am sitting here with Christina Lee. Christina, thanks so much for coming in to chat with me.

Christina Lee

Thanks so much for having me.

Emily Silverman

So we last saw each other in January 2020 at the live show. This was all pre COVID. So tell me how you have been since then? Since, obviously, a lot has happened in the world.

Christina Lee

Oh my gosh, that's a huge question. It's been crazy and difficult and a roller coaster for sure. But emerging from that now and kind of starting to see a glimmer of possibility of some sort of normalcy has been helpful. But there were some dark times, it was really hard.

Emily Silverman

Talk about the night of storytelling and what that was like for you.

Christina Lee

That night was so much fun, like really one of the most special nights that I can remember. And I think it was just this sense of community in that room. It was a huge auditorium, but it really felt intimate. And I remember actually standing there during my story, and I could still see the audience a little bit, it wasn't totally blacked out. And I remember just like a couple right kind of front and center, and they were just like smiling and laughing. And it just felt really warm and really welcoming. And I really just felt honored actually to be on that stage with the other storytellers. Everyone's story was just so different, yet so interesting and meaningful and everyone was so supportive. I remember every time someone came back from telling their story, we would stand up and give him a standing ovation in the green room. It was really fun.

Emily Silverman

So in this story, you talk about taking transport call during residency, and you paint a pretty vivid picture of what that was like. Now that you're out of residency, do those memories feel far away? What is your perspective on that time?

Christina Lee

That was well over 10 years ago, and the memories are actually still pretty vivid. I think part of it was that I journaled a lot during that time just to help me process everything and I had a little blog. Google had blogs. And writing down in the moment helped cement that into my memory. And so I think back at those times, and it doesn't feel that long ago.

Emily Silverman

And remind me, the transport call responsibility, was that once a week, or was it a week block, or was it a month block? Or how much time were you actually spending in that role during residency?

Christina Lee

It would be for two weeks at a time. When usually if we were on like an easy elective that didn't have call, then we would be put on transport call. So maybe two weeks at a time, a few times a year, but you could also moonlight and take transport call. And so I guess in those shifts where it wasn't filled, you could sign up and you would get paid a certain amount just to be on call. And if you actually went on a transport, you'd get paid a lot more. So there were some residents that were really into it and would take call all the time.

Emily Silverman

You mentioned that you're working in urgent care pediatrics right now. Tell us about that. What's that like?

Christina Lee

Urgent care is really fun. I think I was drawn to it just because every day is completely unpredictable. I like that unpredictability. I like the variety. It can be really fast paced, but it can be really mundane sometimes too. It's a lot of fevers and colds and minor injuries. But it's still really fun. And I love to interact with the patients and the families.

Emily Silverman

How did you land in urgent care?

Christina Lee

Well, I actually wanted to be a hospitalist when I first started outside of residency, and I got a bunch of moonlighting jobs, and I also got an urgent care job just because I needed some more hours. And in residency, our urgent care was actually attached to the emergency department. And so it was really like the simplest of simplest things. And I didn't actually enjoy it that much, but when I started working out in the real world, in urgent cares, we actually saw higher acuity. And a lot of patients I learned just avoid the emergency room at all costs. And so we would get febrile seizures and anaphylaxis, and really bad asthma and bad fractures. So it was kind of this combination of ED and urgent care, but without like gunshot wounds, and like real trauma and real emergencies, because that's a little too intense for me. So I liked that kind of hybrid. And I also never was that interested in just general pediatrics, I kind of like some sort of pathology a little bit more. And so it was a little too much of, not that it's not important at all, of course, but just like normal development and behavioral issues, and a lot of it is actually parenting, which isn't really medicine. So I always kind of skewed more towards illnesses and injuries.

Emily Silverman

In pediatrics, we hear a lot about how, yes, you're taking care of the child, the patient, but in some ways you're almost taking care of the parents more. And that you're dealing with families and the family unit. How does that show up in the urgent care?

Christina Lee

That is my daily life. 100% it's almost always more that you are calming fears and anxieties in the parent, especially in the younger kids who are totally fine a lot of the time. I mean, they do have something, they have a fever, they have a cough, but the kid's as had pneumonia, she's in the hospital, could he have pneumonia? What happy as can be. But the parent is so worried about "my grandmother does that mean?" Or "I have friends who have babies who are in the hospital with RSV right now," and the baby is sitting there smiling totally fine, not a sniffle or a cough, but that's their worry. And so I feel like most of my job is actually explaining to parents, reassuring them. Figuring out what their actual concern is—what that fear or anxiety is behind what seems like a simple cold or a fever.

Emily Silverman

Is locating the patient's fear something that you feel like you were taught in medical school and residency, or is that something you learned along the way? And how do you do that work when you have a full list of patients to see?

Christina Lee

Yeah, that's definitely nothing I learned in residency or medical school and something I have just been learning and am still learning as I practice medicine. I think in the beginning, I was really just focused on the chief complaint and what's the diagnosis and what's the treatment, but I've learned over the years that that focus is not helpful to the parents. And it is such a challenge because we get 15 minute blocks. And we're often just packed one ride after another. Every 15 minutes, you're meeting a new patient, a whole new family. And I think the hardest challenge in urgent care is that most of these patients we've never met before. And so it's not like you have that relationship of years of trust built with their pediatrician, you're just this new person. And sometimes there are patients we see over and over again, and you do kind of build a relationship, but often you, you need to establish that trust in like five minutes, and then have them be able to trust you with their child's health and their care. And so it's really tricky. One thing I've started just doing is after kind of them listing off the symptoms, and everything else, I just say, "Is there anything else that's worrying you or that you're concerned about today?" just to kind of get at a deeper thing, or sometimes the patients will offer it and instead of just passing by over a mark they made of like, "We're so stressed right now, and my mom's in the hospital" and blah, blah, blah, but then kind of like taking that little hint of like, "Oh, I'm so sorry to hear that," and then you uncover the real concern. Or just at least understanding more of where they're coming from, what stress has been going on that day or in their lives at that moment. And just the acknowledgement of that often is enough to build that little bridge that you need to connect.

Emily Silverman

So how many patients do you see in a day, roughly?

Christina Lee

It depends on the shift. But we are pretty much booked every 15 minutes, and I'll work seven to nine hour shifts. And there's some breaks in between. So maybe 20-25 patients a day.

Emily Silverman

It's a lot. I mean, I know to any community doctors listening that probably sounds normal. But in academic medicine, the censuses are usually smaller than that. And so that sounds like a lot. Do you find yourself coming away from those workdays energized or drained? Or it depends on the day? Or how do you keep up your stamina?

Christina Lee

It definitely depends on the day. The Delta wave, it hit us hard. And my whole department has been super burnt out. And a lot of compassion fatigue. And so one not so great patient encounter will just color the whole rest of the day. And it's hard to keep up that pace when you're kind of under that shadow. So I started to do a reset, like one day started off really terribly. Just within the first hour, I was a half an hour behind. I had two really difficult parents and a medical assistant was like, "It's gonna be a day." And I was like, "We're gonna reset, I'm pressing the reset button right now. Ding. And we're gonna start all over." And then the next patient was lovely. And I think it's just reframing because ultimately, there's only a couple difficult patients, if any, each day, but most are just really lovely and sweet families and sweet kids. And just trying to focus on those encounters, that's what gives me energy. I mean, kids are fun. A lot of times they're quick, easy visits, and you can just talk about dinosaurs and trucks, and it's really fun. And I think focusing on that is what sustains me through the day.

Emily Silverman

You mentioned that COVID has been causing a lot of burnout where you are. Has it been having to do with attitudes among families around the vaccine? Or just the pure volume and the stress of the vaccine not being available to kids?

Christina Lee

I don't think it's hesitancy against vaccines. I work in an area that's highly vaccinated, and so that's not a huge issue for us. It was definitely the volume. It was tricky because we had for most of 2020 separated all patients into respiratory care clinics. And then in our urgent care, we didn't see those patients, but we started bringing those patients in once Delta hit and all the kids were back in their activities and everything. It was just this flood of patients and mainly a lot of them just needing tests. Some of them actually worried about their kids having COVID. And so it was this combination of sometimes a lot of anxiety from parents and trying to calm that down. And this balance of yes, COVID is something we take really seriously. And at the same time, your child's probably going to be okay even if it is COVID. So I didn't want to not give it the weight that it deserves, but in reality, most of the COVID cases we were seeing were really simple and the kids were fine. So balancing those anxieties. A lot of demanding parents who just want to test because they need to get back to their lives and they need to get their negative test. Just fielding all of that was really hard and just draining.

Emily Silverman

Yeah, I don't have kids myself, although I am expecting. But a lot of my friends do have kids, and it just sounds like as soon as there's an exposure in the classroom, everything falls apart. Or as soon as one kid gets a respiratory illness, whether it's COVID or not, it's like the other kids suddenly like can't go to daycare.

Christina Lee

It's like one domino falls and then the whole thing falls.

Emily Silverman

Totally, which I imagine might be driving some of this, like, I just need a test, I just need my negative test. And so I imagine that must have placed a huge burden on urgent care pediatrics, just trying to shuttle through even just the negative tests alone so that people can get back to their lives. Is that something that fell on your shoulders as a physician, or were there systems set up to handle that influx of need?

Christina Lee

There were some systems, but it was kind of convoluted and very confusing for the patients because it always kept changing. Initially, patients couldn't even come in, and so they would have to do a video visit. And then we would order a test. And then they would go to a test only site and then get their test. But then we started doing the test ourselves. And so patients figure that out. And then they just wanted to come in and we had a rapid test. And then everyone wanted the rapid test, because you could get those results back in an hour and they could go on with their lives. But then we realized we were just becoming this testing center of patients who really not worried about their kids cold at all, but just needed a test. So then we kind of changed that. And we weren't doing the rapid test anymore. Patients can now just schedule the test themselves online, but they don't even realize that they can do that. Because everything keeps changing, it's hard for even us to keep track, but then for the patients to keep track as well. So there are systems in place, but it's not streamlined and it's not easy to communicate.

Emily Silverman

I want to come back to your story because it's such a beautiful story. And you talk about how there was this cowboy feel bumping along the road and the ambulance. And then you focus in on this quiet ambulance ride with the dying girl and her mother. And as you're riding in the ambulance, you're looking at this patient, and then suddenly, you're remembering Brittany, and you're remembering Adam, and you're remembering all these patients from your training. Was there something about the patient that really made you take stock? Bring us into that moment in the ambulance, and why that small moment felt bigger to you, and why you chose that to submit to The Nocturnists.

Christina Lee

Often in residency, there were patients that we all knew who were always in the hospital, who practically lived in the hospital. And so we would hear of different developments in their care or if one of them passed. But this patient I never had even heard her name. I didn't know anything about her. And I kind of wondered what her story was. And so I kind of reflect back on all the other patients that I had met in a similar situation of having cancer and eventually dying. I think all those patients I mentioned in my story eventually did pass away. I would have dreams. And I remember one patient in particular that I just fell in love with. He was the sweetest four year old boy. And after my rotation for months afterwards, I would have dreams where I was just bawling and bawling. And I'd wake up and my pillowcase was covered in tears. And I think those kids just really warmed their way into my heart. The only life they knew was being in the hospital and being sick. It was just heartbreaking, but also I felt really privileged to witness and just be part of their story.

Emily Silverman

As you walk us through all of these different patients in your memory, there's quite a bit of humor that comes up. The one that comes to mind is the boy who was eating the doughnut and you turn on the lights and he said, "Don't turn on the lights the doughnut will melt" or something like that. Having worked this rotation in pediatric oncology and working with kids who are extremely sick, in some cases terminally sick, do you think that kids cope with that differently than adults? And if so, how?

Christina Lee

I do think kids cope differently. I think as a child, you are always told what to do. You have very little control over life. And so you just kind of accept what the grown ups say is going to happen. And same thing goes if you get sick, and so it's almost like not routine, but you're going into the hospital, you're going to get this port placed under your skin. And they're like, "Okay, I guess that's what Mommy says I have to do." And so I guess there's an acceptance that happens with kids, and maybe not even realizing how completely abnormal their life is, because that's the only life they know. And so I think there's less of that anger or need for control, or comparison to what their life was like for adults, or even like older adolescents, I would say is a lot different than the really young kids.

Emily Silverman

Were you interested in storytelling in medicine, before your performance at The Nocturnists?

Christina Lee

I only started thinking about storytelling in medicine after hearing The Nocturnists. I learned about it from a colleague, and I tuned into the podcast, and I was hooked. And every story, even if it was a completely different type of medicine, there were moments where I just connected and I felt like "Oh, they get it. That's what I felt, or that's what I experienced." And I think that was really, almost healing for me. I think a lot of those stories I held on to from residency and didn't have anything to do with them, but they obviously affected me and shaped who I am. And so to know that other people grappled with similar experiences, or had stories that they held on to helped with the process of healing from a lot of that sadness and that grief. Now, with COVID, hearing all those stories as well, especially at a time when life felt so isolating, just to hear the different ways people were experiencing that in their lives was also a way to kind of connect and be in community.

Emily Silverman

Hearing you talk about the parents that you deal with in your practice, while also being on the journey to becoming a parent myself. God willing, I'll have a healthy baby girl. My first. Our first, my husband and I. And I really don't know how I'm going to respond to the existence of this new person. Like, I don't know if I'm going to be one of those physician parents who is like, "Oh, you're bleeding, it's no big deal. I've seen worse." Or if I'm going to be maybe more anxious. And I'm not even a pediatrician, I take care of adults. And at times, I feel really grateful actually, that I forgot a lot of my pediatric medicine because it just gives me less to fixate on and worry about. So I guess my question is, what is it like being a pediatrician and a parent? How do you toggle between those roles? And then what advice do you have for a new parent like me?

Christina Lee

So much of parenting is not pediatrics. I remember when we first had my son, my husband was just like, "Well, just whatever you say, I'll just do that." But I was like, "I haven't done this, either. Like, I don't know anything about breastfeeding or like bathing a baby. I've seen the nurses do it, but I don't sit there and bathe babies, or like even diaper changing." So much of it has nothing to do with what I learned in residency, or med school at all. I think it helps in that I've seen how bad it can get and so I know when there's really nothing to worry about. Ultimately, you are not your child's doctor. So really trying to delineate that, like you are the parent, you have a lot of roles to play in this child's life. But diagnosing their illnesses and their potential learning issues, that is not your job. And so to find a pediatrician you really love and trust, that's probably the biggest help.

Emily Silverman

You've mentioned a couple times during this conversation that a lot of what it means to have a child—things like breastfeeding, bathing, developmental milestones, behavior, learning—that these aren't really things that we focus on in medical school or pediatrics residency, that it's much more disease focused. I know that you said your preference is actually more diseases and pathology, but do you think we need to be incorporating some of this other stuff into our medical education? Like should we be more knowledgeable about breastfeeding as a profession? Should we be more knowledgeable about parenting philosophies? Or is it best left to the psychologists and all those parenting books and other disciplines?

Christina Lee

I think we absolutely need to. And all the pediatricians I know now have just learned that outside of residency in their practice, because parents go to their pediatrician for all of that. And they expect them to know about how to handle tantrums and picky eating, and all these things that I remember getting like maybe one lecture in residency about. 30 minutes about what to do with a picky eater, which is totally insufficient. And so so much of that is just learned on the job, and also just being a parent themselves I think. It's hard because there's so much to learn in residency, but especially those going into general pediatrics. It is so much of what parents come to pediatricians for.

Emily Silverman

I was talking to a friend the other day, and she's a pediatrician. And she just had a kid a year or two ago, and she said that it totally transformed her approach to her patients. And so I'm wondering, when you had your kids did that happen?

Christina Lee

Definitely, I think having kids made me a better pediatrician. And not to say that, I know plenty of pediatricians who have no children who are wonderful. But I think for me, in particular, it was always hard for me to connect with the crazy fatigue and a complete overwhelming experience of having a newborn. I just didn't get it. And so these parents would come in for like their bilirubin checks. And I would just do the things and check their bilirubin and your baby's fine. But now those are my favorite visits, because I just remember that time, and I just feel for those poor, exhausted parents. And you can just see the complete sense of being totally overwhelmed in their eyes and totally sleep deprived. And I just love those visits because I remember what it's like, and I love to just be there with them in that and just say, "You're doing a great job. Your baby looks great. It's gonna be okay." It's really fun.

Emily Silverman

Even just hearing you say that in a hypothetical is calming me. Well, it's been so great talking to you, Christina. Thank you for coming in to chat with me today. Thank you for telling that beautiful story on stage at The Nocturnists and for continuing to listen and for being a part of The Nocturnists family.

Christina Lee

Thank you for having me.

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