Now and then in clinic I say this: “You can graduate now.” It is when the follow-up a child needed after surgery has been completed without incident, or when a problem we had been worried about got better on its own and no longer needs watching. The parent thanks me, and the child stands there with a face that does not quite know what the words mean, then follows them out. When the door closes I open the next patient’s record. That is how it ends. Nothing in particular happens.
It is a strange thing when you think about it. Diagnosing, operating, explaining and waiting — all of that time is pointed towards the day the child no longer has to come to hospital. Yet when the day comes, a brief goodbye is followed by the next appointment. A worry carried for a long time comes to an end, and the day in clinic is no different. The best outcome passes the most quietly.
When a complication occurs, the record grows longer. If a second operation is needed, we go back over it at the departmental conference, and every time I see a similar patient the judgement and the operation itself come back to me. What went badly is given a name and a place in memory. The chart of a child who finished follow-up without any trouble, on the other hand, simply gets no further entry. The chart just stops.
So when I look back over past practice, the memory tends to tilt to one side. The child who developed a fistula, the one whose operation did not go as intended, the one whose course was not what I expected — their faces and even their parents’ words come back. The days that ended uneventfully blur together. There are reasons for the tilt. To go back over a judgement and avoid repeating the same problem, you have to look at the uncomfortable memory for a long time. But as the days that passed without incident are buried one by one, much of the room in memory fills up with the hard ones.
Being wary of problems that have not yet shown themselves and acknowledging a good result that has been confirmed can be done at the same time. Yet I have been unusually stingy with the second. When the operation went as planned, recovery passed without incident, and I have seen in clinic that the child is doing well, surely I could be glad of that for a moment.
Caring for children, I mostly do not know what kind of adult a child became once their care was finished. If the child grows up and lives without thinking about the operation, or about me, that too is the good outcome I wanted. The brief goodbye on the last day can end up being my last memory of that child.
Some good outcomes are confirmed by meeting again in clinic. Some of the children who had difficult operations keep coming back at intervals. When I see one of them after a long gap, doing well, the memory of that hard day in theatre feels a little different. The hard hours in the operating room were not mine alone. The time the child and the parents endured was longer than mine.
Meetings like that stay with me like a medal kept inside the chest. Without showing it to anyone or explaining it, the fact that this child is living their own life becomes a kind of pride for me. Even through a run of hard operations and hard clinics, what keeps me in this work sometimes comes from memories like that.
So I sometimes leave the words “doing well” in the chart of a child who is. It goes after the findings that have to be recorded — a slightly private entry. It is written so that when I open the chart again later, something of today comes back with it. What I worried about and what went badly will stay with me without any effort; for what went well, I want to leave at least a small mark myself.
To some children I say “you can graduate now,” and for others I set the next appointment. If I can write “doing well” at the end of that child’s record, I try to let myself relax for a moment too.