Yeah, I know the perverse associations the public has with The Catcher in the Rye but it does have a strong message. I read it when I was a freshman in high school (which, at this point, is literally half a lifetime ago) and this passage really struck me:

'You know that song "If a body catch a body comin' through the rye"? I'd likeâ€â€'

'It's "If a body meet a body coming through the rye"!' old Phoebe said. 'It's a poem. By Robert Burns.'

'I know it's a poem by Robert Burns.' She was right, though. It is 'If a body meet a body coming through the rye'. I didn't know it then, though 'I thought it was "If a body catch a body",' I said. 'Anyway, I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody's around nobody big, I meanâ€â€except me. And I'm standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliffâ€â€I mean if they're running and they don't look where they're going I have to come out from somewhere and catch them. That's all I'd do all day. I'd just be the catcher in the rye and all. I know it's crazy, but that's the only thing I'd really like to be. I know it's crazy.'

On the other hand, there is the sequence toward the end of the book where the main character Holden watches his sister Phoebe riding a carousel, trying to reach for the brass ring, and he fears that she's going fall off and break her neck. But he comes to this realization:

The thing with kids is, if they want to grab for the gold ring, you have to let them do it, and not say anything. If they fall off, they fall off, but it's bad if you say anything to them.

Suffice it to say, this book has had an impact on my relationship with my own sister. But the reason why I thought of it now is that I have just finished my pediatrics rotation, and the ideas presented in this passage have run through my head. I am seriously contemplating doing pediatrics, or maybe a combined internal medicine/pediatrics residency, and these thoughts have a lot to do with why I want to do it. Yeah, I know that you can't protect everyone, that trying to be the catcher in the rye is ludicrous, that you are just one person, one stranger, and there are a lot of people in the world who do horrible things to children, and really, you're just a doctor, the best you can do is fix the physical problems, but most of the social problems tend to be intractable, and while there are some really powerful mechanisms out there by which you can try to protect a child, they are imperfect, and it becomes difficult to reverse the damage already done.

But I suppose it depends on where you work. I did my rotation at a county hospital, and there, you actually aren't alone. There are teams of doctors and social workers, an entire network buttressed, for good or for ill, by the state, and while people still slip through the cracks, it isn't because we didn't try.

And in the end, all you can do is encourage, and be there, and realize that there is only so much you can do, your actions are circumscribed, you are not out there to save the world, but to do some very limited, though important things. Like, first, do no harm. In the end, the child grows up to an adult and has to make their own decisions. It's one thing to control the life of a 9 month old infant sitting in the isolation room because of miliary TB, quite another thing to tell a 16 year old how to live her life.

So I'm still trying to figure out why I can't just do Internal Medicine, why Pediatrics has such a pull on me. I mean, sure, little babies are cute and everything, but that's only a fraction of your patients. Then there are the toddlers who fight you (not to mention their parents) at every turn. Then school children, adolescents, young adults. Each population is markedly different. And then, I have learned the rule of Internal Medicine: "The delivery of medical care is to do as much nothing as possible." (courtesy of the Fat Man, from The House of God by Samuel Shem) While it's easy to apply to the 76 year old COPD/CHF/CAD/diabetic/ascitic patient who still smokes, can't stay away from salt, fat, or sweets, and still drinks a 6-pack a day, and you're contemplating whether or not you should try something invasive, well, the rule saves you much time and agony, and will probably prevent the patient's quality of life from deteriorating faster than it already is. Less is more. But when it comes to kids, I think there is something instinctual about wanting to do as much as you can. Even though, sometimes, even with kids, nothing is better than something.

There will be plenty of pondering to do, I suppose.