I had an epiphany of sorts on the train today. I was riding in relative peace–as much as was possible wedged between two strangers in a car whose air-conditioning was a bit like a gentle breeze in Death Valley–when a nearby two-year-old began to cry. This was no “I’m scared” cry, or “I’m hurt” cry. No, it was an angry cry, one whose screeching pitch rose and fell like the tides, one whose tantrums crested with piercing squeals as the child arched his back and kicked his legs in convulsive fits.
A pleasant middle-aged black man riding across from me smiled at the struggling father and asked, “How old is he? Two?” The father nodded. In that moment, I could think of no other age that so deserved the modifier “terrible.”
In fact, the cries brought me back to my time doing pediatric anesthesia. For those rare children whose parents refused oral premedication on their behalf, a trip to the operating room may have well been like checking into a nice stay at Abu Ghraib. And for these children–a particulary wiry and surprisingly strong eight-year-old getting a questionably medically necessary circumcision comes to mind–gently inducing anesthesia was a two-, or sometimes three-man job. More than once, I’ve stood behind a child who sat on the operating room table facing his mother and wrapped my boa-long arms around his body, pinning his arms to his side, while the attending held the cherry-flavored mask to the little head which was frantically flinging itself left to right, left to right. With every deep, visceral shriek, I could just imagine the little molecules of sevoflurane being whisked from lung to capillary to heart to brain. No child can withstand a compelling inhalational induction of anesthesia. Grisly, but strangly satisfying.
And so it was, as the cries brought me back to the rattling subway car, I slowly opened my bag and pulled out the pink bubble-gum mask. The father, seeing this, grimly nodded and handed the child to me. His dark, confused eyes surveyed the new face before him while his shallow panting afforded our ears a brief reprieve before the fierce wailing resumed, the back arched, the little fists pounding against the orange plastic seats. As I pressed the mask against the child’s face, the sobs became muffled and shorter, and then, eyes rolling back, blessed, quiet sleep came. I handed the little one back to his father as the subway ground to a stop and the doors opened. A last glance at the car before exiting showed every beaming face raised, every mouth upturned in a thankful smile.
Okay, so I made up that last paragraph. But oh, what I would have given to knock that little kid out (anesthetically, of course). It was startling, though, to realize that I wouldn’t have done it only for the sake of my hearing. No, when those situations arise–not that I would ever choose to be in them–there’s also some element of primative power struggle, and it’s gratifying to win…even against a two-year-old.
In my defense, I don’t believe I’m a horrible doctor and a horrible person. Just reflective. The same essay could probably be written about law-enforcers, or CEOs, or even a flight attendant dealing with an unruly passenger… With many (most?) jobs, there’s a difference in power, and when individuals’ goals are in conflict, that power advantage–be it physical, mental, social, or rhetorical–can be, shall we say, compelling. The intentions and the circumstances may determine the moral and social acceptability. Anyone remember Rodney King?
What I realized is that unpleasant as it is to put a fighting child to sleep (“Disgusting,” I remember my attending muttering after the aforementioned eight-year-old was anesthetized, referring to our brute force, not the child’s lack of cooperation), it’s generally regarded as necessary in some circumstances, and it accomplishes a greater good, so it’s okay. But if I’m honest, I have to say that a primitive part of me actually finds it satisfying.
Obviously, the hypothetical scenario I described on the subway would have been a display of power not out of necessity or because it was accomplishing a greater good for the child, but simply because it would have given our ears a rest from the painful cries. The epiphany was that I would have definitely enjoyed putting that child to sleep for the good of everyone on the subway. Clearly this is ethically indefensible, and so those motivations were filed away to some hidden part of the consciousness, and I continued reading my magazine in a socially acceptable manner as other nearby riders rolled their eyes and the wheels continued clicking along the steel rails.