Aneri Bhargav Patel, BS
WMJ. 2025;124(4):321, 323.
Jaylen lay curled in the hospital bed, his small frame dwarfed by stiff white sheets and a towering IV pole. His cracked lips and reddened eyes squinted. At 6 years old, fatigue and discomfort weighed heavily on him. His grandmother sat beside him, her face etched with anxiety and grief. As a third-year medical student on my first pediatric inpatient rotation, I listened as the team discussed differentials: Kawasaki disease, scarlet fever, or scalded skin syndrome. The plan was intravenous immunoglobulin (IVIG) and aspirin. Yet, standing by Jaylen’s bed, the situation felt far from academic.
In my notes, I had written, “albuterol inhaler every 4 hours as needed,” following standard protocol for mild intermittent asthma. It wasn’t until late afternoon that I noticed something was wrong. Jaylen was struggling to breathe; his chest heaved with each inhalation, intercostal muscles retracting like taut strings. A dusky blue tinged his lips. His eyes were crusted shut, and his grandmother’s tearful gaze met mine. My heart raced.
I immediately paged my senior resident. Within moments, a respiratory therapist was at Jaylen’s bedside, administering nebulized albuterol. The team acted with calm urgency, but I couldn’t shake the realization that the medication hadn’t been ordered earlier. My note hadn’t translated into action; it was a pended order lost. I felt a sinking heaviness. Was it my responsibility? I was just the student, but I had seen the need. I had written it down. Why hadn’t I followed up?
That evening, I sat with Jaylen’s grandmother. She told me Jaylen wanted to be a firefighter. She smiled as she said it, though her voice trembled. “He lives with me,” she said. “His mom… she’s not around much.” Jaylen had been terrified to come to the hospital, haunted by past visits filled with blood draws. “But today,” she said, “he let them examine him. He let you help him. Thank you for being here. Will you still be here tomorrow?”
Her question lingered with me. I promised her I would be there.
That night, long after signing out and returning home, I kept thinking about Jaylen. About the moment I saw him struggling to breathe. About the silence before the respiratory code. About how close we came to missing something essential. I thought about the systems we trust – notes, orders, workflows – and how easily they can fail. How easy it is for a patient – especially a child like Jaylen – to become lost in the shuffle.
Unexpectedly, I thought about Sanju.
Sanju was a boy I met years ago in Gujarat, India, in a small farming village called Vicchan. He had collapsed in the fields from heatstroke after working under the harsh sun. His parents had never taken him to a doctor before and were reluctant now. But the local doctor – the one everyone knew and trusted – came immediately. He administered fluids and reassured Sanju’s parents with gentle words. He stayed long after, sitting with them, teaching them how to prevent it from happening again.
That doctor was my father.
As a child, I watched him with admiration, but only now do I fully understand what he gave his patients. It wasn’t just medical care. It was presence. Trust. The knowledge that someone would show up, day after day, with open ears and open hands.
Jaylen reminded me of Sanju – two young boys in distress, their families fearful and uncertain, their futures precarious. But also two moments when presence mattered, when being there – fully and attentively – made all the difference.
The next day, when I walked into Jaylen’s room, his eyes lit up. His breathing had improved. The albuterol had helped. He was still covered in a red rash, still in pain, but he reached for the toy fire truck on his bedside table and told me he wanted to be the kind of firefighter who rescued cats from trees. I smiled and said, “That sounds like the best kind.”
In medicine, we often focus on science: evidence and guidelines. We pride ourselves on knowledge and precision. But Jaylen’s case reminded me that medicine is also about noticing. About pausing long enough to see the full picture, to truly see. It’s about hearing the rasp in a child’s breath that doesn’t quite match the numbers on the chart. It’s about noticing the grandmother’s furrowed brow, more concerned today than yesterday. And it’s about sitting with a grandmother who is scared, terrified of losing her loved one, and letting her know you’re with her and not going anywhere.
I still think back to Jaylen’s case. It taught me that caring isn’t just what we do, it’s how we do it. With attention. With heart. When I think about the kind of physician I want to be, I think about my father. I think about Sanju. I think about Jaylen.
A few days later, as I was leaving for the day, I passed Jaylen’s room. He was asleep, the toy fire truck clutched in one hand. He had been downgraded from the NICU back to the pediatric inpatient room adorned with caterpillar stickers and butterflies on the wall. An IV pole with a bag of IVIG hung beside him. His grandmother looked up and smiled at me from her chair, a tired smile that carried trust. My heart warmed.
I nodded quietly and kept walking, carrying that smile with me into the hallway, into the next room, into the doctor I hope to become.