My Sunday 24-hour call shift as a pediatric anesthesiologist began uneventfully. Two patients presented with acute appendicitis, while a third patient had sustained a forearm fracture from a trampoline misadventure. My cases went well, and I started to imagine that I might experience an “easy call.” I even began to think of a few errands I could run on my way home.

I was discharging my last patient from the PACU when I heard a STAT overhead page, “Anesthesia report to the PICU.” At that moment, I knew that the “easy call” was not to be. I ran up the three flights of stairs and was ushered into an overly crowded room. I squeezed between the PICU attending and the respiratory therapist who were desperately trying to bag-mask ventilate an infant following multiple unsuccessful intubation attempts. Blood was cascading from the patient’s mouth with each squeeze of the Ambu bag. I had that heavy feeling in my chest of both fear and dread as I faced this dire situation. At times such as these, I make a conscious effort to remain outwardly calm to prevent my emotions from having a negative impact on my clinical skills. I performed a quick direct laryngoscopy and slipped an endotracheal tube through the glottis.

Relief washed over me as the prolonged and active resuscitation resulted in a palpable pulse and a measurable oxygen saturation. We hurriedly transferred the patient to the operating room to repair the aorto-esophageal fistula. My patient had ingested a button battery, which had eroded through his esophagus. I was afraid that the chance of meaningful survival was small. Nonetheless, I have been surprised by the unexpected resiliency of many of my young patients, who make a full recovery.

After a successful surgical repair, I returned the patient safely back to the PICU, where his parents greeted me with a warm embrace and tears of gratitude. I wanted to cry with them but held back my tears. I often wonder how expressing my emotions is interpreted by my patients’ families. Does it make me appear unprofessional or authentic and compassionate? I decided to remain professionally reserved. After giving report to the PICU staff, I headed out into the hallway and leaned against the white cinder block wall.

My five-hour adrenaline rush was beginning to subside, and I needed a minute to decompress and process my feelings.

I ran quickly down the stairs, sliding my hand along the banister to keep my balance. As the automatic glass doors to the parking garage opened, I remember feeling the warm Texas sun bathe my face. I opened my car door and felt tears sliding gently down my cheeks, a response to both enormous joy and pure exhaustion.

The following morning, I woke up early to make a postoperative visit on my patient before starting my cases. I felt a special connection to this family and thereafter, I made it a priority to visit daily. On postoperative day two, I entered my patient’s room to find him being held in his mother’s arms. My patient and his mother both shared the same bright blue eyes and shiny auburn hair. The happiness I felt when I saw mother and son reunited reminded me of why I became a pediatric anesthesiologist. The patient’s mother handed the nurse her phone and asked her to take a picture of the three of us. I leaned over the wooden rocking chair, and we all smiled at the camera. My inclusion in the family photo album made me feel special and valued.

Five days later there was an unexpected overhead page, “Anesthesia STAT to PICU Bed 13.” A sense of dread washed over me. I had been in my patient’s room that morning as the nurses were reviewing discharge instructions with the family. We had said what I thought would be our final cheery goodbyes.

I ran out of the doctor’s lounge and proceeded to an open elevator, exiting on the fifth floor. I entered my patient’s room and was shocked by a chaotic scene. After a few minutes, I realized that this resuscitation would not be successful as my patient had rebled and exsanguinated. I was stunned, but immediately turned my focus to my patient’s parents who were standing at the foot of the bed. I hugged his parents tightly as they shook from shock and grief. I cried as I told his parents that we couldn’t save their child’s life and then joined the PICU doctor in a family conference that included a recommendation to discontinue a futile resuscitation. I felt a profound sense of sadness for a family whose lives had been shattered.

That night I went home, made dinner, and many hours later briefly shared with my husband some general details of these tragic events. I then sat down and started to write about my trauma, which I find to be quite therapeutic. After I am done expressing my feelings in print, I feel a sense of relief as if my pain has been left in the written story.

The next time I saw my patient’s family was at the funeral service, which was full of young children and families singing, playing, and praying. As hundreds of live butterflies were released, my patient’s three brothers reached up to the sky with their tiny, outstretched hands. I watched the butterflies fly away and felt empty. That emptiness is continually refilled by the human connections I make with my patients and their families.

Six months later I received a delicate wooden butterfly in the mail. It was attached to a bright green ribbon and arrived with a handwritten note of gratitude from my patient’s family. The butterfly now hangs from the latch on my kitchen window, next to a tall vase I keep full of fresh wildflowers. I am reminded every day of how beautiful and fragile life is and how fortunate I am to participate in these intimate moments in my patients’ lives.