Book Review

Attending Children: A Doctor's Education

N Engl J Med 2005; 353:1077September 8, 2005

Article

Attending Children: A Doctor's Education
By Margaret E. Mohrmann. 212 pp. Washington, D.C., Georgetown University Press, 2005. $24.95. ISBN: 1-58901-054-X

Narrative medicine is a way of incorporating patients' stories into the healing process. It permits physicians to reflect on the physician–patient relationship and to apply their insights to the care of their patients. Vignettes about experiences with patients can improve a doctor's appreciation of the context of a patient's illness. The stories related by Mohrmann in this book illustrate the best practices in narrative medicine.

Mohrmann is a senior academic pediatrician with additional training as a theological ethicist. The stories encompass her varied experiences during a 30-year career in pediatrics as a resident, a faculty member of a pediatric intensive care unit, and a primary care physician in an academic center. As she matures and the focus of her career changes, she also matures in her approach to patients and families, retaining her sense of wonder and heartfelt humility.

Mohrmann's long career will make this book appealing to physicians across generations, as well as to academic faculty and practitioners. Medical students and residents will relate to the transforming nature of Mohrmann's encounters with patients, because she details how her patients have helped mold her into a physician who “attends” to her patients in all meanings of the word: listening, accompanying, and waiting. In fact, Mohrmann organizes her book around these three dictionary definitions of “attend” to describe her journey.

The narratives about Mohrmann's residency at Johns Hopkins Hospital, in Baltimore, include details of her initial experiences with giving bad news and her perceived failures in this regard. She discusses how subsequent feelings of inadequacy helped her to move forward with humility, introspection, awe, and openness to learning a better way. She shifted from worrying about her performance to being concerned about her patients' well-being.

Mohrmann writes of the unexplainable coincidences that defy probability and scientific and medical reason but reinforce faith and hope. And she states that “the joy and, on occasion, the terror of being a doctor or a nurse lie in being exposed, time after time, to the `more' that's always there.” Finally, she admits that the experiences of her residency allowed her to become an empathetic physician. To foster her own emotional growth and well-being, she chose to “be there” for her patients; this, she explains, is the “accompanying” part of attending.

Mohrmann's experiences as an attending in a pediatric intensive care unit and a nephrologist at the Medical University of South Carolina, in Charleston, extend the repertoire of stories to those of children who die or defy death with sometimes miraculous recoveries. The final chapters of the book deal not only with Mohrmann's role as a primary care physician to children who have social problems but who also possess the resilience to overcome obstacles. Mohrmann's challenge during this phase of her education was to discover and negotiate the appropriate boundaries of her relationships with the families of her patients. In her book she articulates that decision-making process.

Attending Children is an extraordinary book. Mohrmann has a clear gift for language, and she enables the reader to care about the children and families she portrays so eloquently. That health care professionals are never too experienced to keep learning from patients, and that a doctor's humanity is shaped through honesty, sincerity, and being there to “attend,” in all its meanings, are powerful messages for all who care for and about patients.

Kathleen G. Nelson, M.D.
University of Alabama School of Medicine, Birmingham, AL 35294
knelson@uab.edu