These days my work with children as a nurse practitioner in a pediatrics group practice seems to be interspersed with alternate doses full of sorrow and laughter. My patients make me smile, occasionally laugh at their childhood innocence and escapades. They say and do things that often stay with me long after the day is done. They can surprise you at times. Giving you a hug when you least expect it, or that look of wonder when they listen to their heart through your stethoscope, or that smile from ear to ear when you give them the smallest of gifts. Tending to the little people and their older brothers and sisters, who are straining to act like the grownups they aren't, is replete with small glimmers of hope and a rising uneasiness about the future.
Pediatrics is like veterinary medicine. The patients in both disciplines are not in the least bit interested in telling you what's wrong with them. It's up to you to find out. The older ones are not much more communicative than the younger variety. If you get a one word answer or grunt you are doing quite well. Of course, I was once their age a long time again and although it's been a while I haven't forgotten what it was like. Then there are the parents. Struggling as best they can to raise their children. They come in worried about them when their sick, or frustrated with their behavior. Sometimes they are just going through the motions, disinterested and in a hurry to leave.
The nurse practitioner (NP) role was developed in the United States back in the 1960s to address the physician shortage in the inner cities and remote rural areas. At the time, it was considered revolutionary, not to mention unsettling, for nurses to adopt the medical model of health care. In that model, the diagnosis is paramount and from that diagnosis one derives a plan for treatment. NPs were trained to do physical exams, order and interpret tests, to diagnose and to prescribe appropriate medications. Fortunately for their patients, NPs also brought with them the nursing model which consisted of listening to your patient as well as his family and approaching the illness as only one aspect of a complex person. I am not saying that doctors, who are valued colleagues, don't do this, just that a great deal of their training is much too invested in disease and not the humans who suffer from it.
With a ringside seat, I get a glimpse into the lives of the children who come to our clinic. I do so because I try hard to see those kids as more than someone with a sore throat or earache. The glimpse I get is not always the TLC (tender, loving care) that we may expect our kids should be getting. I see kids who live sad, even hopeless lives. Kids who are can't wait to leave home and who are victims of neglect, physical or sexual abuse, violent crime, substance abuse and teenage pregnancy. The children I see run the full spectrum of childhood from neonates to young adults. None of the children I see in my practice lacks for food or basic clothing or even a roof over their head. These are easy things to obtain in our affluent societies. What many endangered kids suffer from in varying degrees is a spiritual poverty that pervades their environment. It emanates from parents who are the products of such poverty, cut adrift without a family support network, totally on their own, ill equipped to deal with the world at large let alone raise resilient children to cope with that world.
Who is responsible for this spiritual poverty? Perhaps we are all to blame. We cultivate it, we look the other way, we enable it, we are part of societies that create ever growing numbers of children who we will be hearing from in the future and who we will have to lock up in order to protect ourselves from them. Lately, I feel like I am swimming against this inexorable tide. Feeling helpless and unable to make a difference in the lives of the increasing number of children at risk. Perhaps my older son Nick has noticed. He recently gave me something helpful to read. It consisted of advice given to a pediatrician by Elder Fr. Porphyrios, who served for many years as a hospital chaplain:
"Listen to what I have to say to you. Every time you examine a child you should offer a fervent prayer with love: Lord Jesus Christ have mercy on your servant.
As he said this he took a deep breath while he opened his hands. It is in this way that you should pray for every child. God has sent a precious soul into your hands. As you place your hands on them pray fervently within yourself that the grace of God will be transfused into the soul of the child.
Do all this things spiritually and in secret. The others who are present won't understand anything. You will prescribe to them medicines which science dictates but in the final analysis Christ will heal the child."
+May all efforts on behalf of children by parents, teachers, and all the adults in their lives be blessed.+