From Rudy’s new room, I can look across the nurses’ station to his old one and it brings back memories of those first days when this whole place was so unfamiliar.  I remember being overwhelmed by mysterious pieces of equipment being wheeled around.  I remember trying to divine the purpose of many procedures I had never seen before.  I remember the parade of people coming in, introducing themselves, their specialty and then examining Rudy.  The raw intensity was such that most of the names escaped me well before their bearer even left the room.

 

A few repeated faces started to distinguish themselves amidst the blur of those first few days.  Rudy’s condition was very tenuous at that point and there was lots of attention being paid to him and all the foreign numbers up on the monitors.  The doctor with lively ties seemed to be in the room quite a bit, watching carefully.  Like everyone else, he watched the numbers tick by, but gave equal amounts of time to watching Rudy—noting his skin tone, the flare of his nostrils and the cadence with which his chest would rise and fall.  Even when he was dealing with other kids in the unit, most of his passes by the room included a quick scan and status check.

 

It was only the most disciplined restraint that kept us from constantly cornering every doctor for detailed explanations on what they were doing and seeing.  There was an instinctive sense that hovering over the staff would interrupt their work and divert the attention that needed to be paid to Rudy.  But even if he couldn’t give a running commentary, the doctor with the ties always seemed to stop at just the right time to give us an update on what was going on.

 

Dr. Henderson?  Dr. Haroldson?  Doctor Richardson?  For some reason it took me quite a few quiet checks with nurses to get straight on the name, but finally I got it that the Doctor with the ties was Rick Harrison.  Remembering his name at this point isn’t much of a challenge as Rick is the second intensivist who has done the bulk of the rotations during Rudy’s sojourn here in the ICU.

 

I’m not sure how one could navigate such a journey as the one we’ve been on without trust in the people we simply need in order for Rudy to have a chance.  As I’m continually impressed by the giftedness and knowledge of most every nurse, tech and therapist, I have nothing but awe left for the doctors.  In position, but more importantly in competency, Rick is at the top as he brings incredible expertise and clinical experience into the very emotional arena of very sick children and the fretful parents that accompany them.

 

As much as I’d love to cling to the notion that no one knows my child better than I do, I probably let go of it well before Rudy was born.  No one loves him more, but it only takes one visit in rounds to be reminded that there are levels of detail I’ll never understand and questions I wouldn’t even think to ask.  For Rudy’s sake, I’m grateful there is expertise that far surpasses our own.  I’ve come to see that his treatment rarely involves black-and-white decisions; but an involved sequence of judgment calls requiring knowledgeable coordination of disparate and often intricate steps.  We are grateful for the many weeks that Rick, with his measured and seasoned expertise, has played this central position.

 

A good doctor at this level is deeply knowledgeable, drawing on science and experiences with thousands of patients.  An exceptional one also recognizes that each patient is unique and at some point departs from the textbook conventions.  We have often heard Rick remind the doctors in rounds that Rudy has his own norms.  He is probably more intricately aware of the data than anyone else and would never flippantly dismiss it, but his overall assessment leaves room for common sense and basic observation.  As helpful as science is, a skilled clinician knows when it should be trumped by simply looking at whether the patient looks peaceful or distressed.

 

We never lose sight of the fact that Rudy’s condition has us in a place of dependence and we are so grateful that one of the key people we are leaning on is one we trust so deeply.  Trish and I have daily discussions about Rudy’s course of treatment, and more often than not they touch on Rick’s opinion.  Rick’s esteem among his colleagues seems to match ours as I can’t recall anyone being offended by the many times we’ve asked if he’s been consulted.  It was only in gathering my thoughts to write this that I discovered that Rick wears another hat—as Medical Director for the Mattel Children’s Hospital.  As far as we can see, they sure have the right guy in charge.

 

We place our trust in Rick not only because of his technical competency, but also because of his ability to appropriately straddle clinical distance.  This journey is about my kid and I’m a human being going through emotions that I’ve never experienced before as I try to comprehend realities I never dreamed I’d have to face.  So, I need guidance from human beings, who never lose sight of the seriousness of the situation or some form of necessary objectivity; but don’t engage without emotion.  They hurt with us; are frustrated with us; know the process well enough to identify milestones worth celebrating; and introduce well-timed humor amidst circumstances so intense it would never be expected.  In light of this, my most vivid memories of Rick do not center around medical details, but on human interactions:  celebrating when Rudy peed enough; overseeing Rudy’s first two extubations; losing more than a couple nights’ sleep at home pondering Rudy’s condition; feeling sad and frustrated with us when we had to go the route of the tracheostomy and feeding tube; and stopping in on an off day to see Rudy and Trish after hearing of the chylous fluid in Rudy’s stomach.

 

Rick describes himself as “the doctor no one wants to see”; because dealing with him means you have a very sick child.  Point taken, but given that I have no choice over the condition Rudy was born with, I can’t tell you how glad for the many times we have seen Rick.