As a clinical, I identify with the child the story, the Star Thrower, adapted from Loren Eiseley

“There was a boy walking along a beach. There had just been a storm, and starfish had been scattered along the sands. The boy knew the fish would die, so he began to fling the fish to the sea. But every time he threw a starfish, another would wash ashore. An old man happened along and saw what the child was doing. He called out, ‘Boy, what are you doing?’  ‘Saving the starfish!’ replied the boy. ‘But your attempts are useless, child! Every time you save one, another one returns, often the same one! You can’t save them all, so why bother trying? Why does it matter, anyway?’ called the old man. The boy thought about this for a while, a starfish in his hand; he answered, “Well, it matters to this one.” And then he flung the starfish into the welcoming sea.”

― Loren Eiseley, The Star Thrower

As physicians, our primary task is to care for our patients, one at a time.  We do this, even while the waiting room piles up, and our waitlists grow.  While the work is endless, each encounter is meaningful to the individual in our care. And when we work together, side by side, the day goes by faster, and with a lens of gratitude we tell ourselves that it is a privilege to be on this beach, doing meaningful work, doing what matters to our patients.

However, from time to time, we look up from our work, and start asking harder questions – Does it seem like there are more starfish than the day before? Are these starfish new ones washing up or are they the same ones? What is happening to our beaches and oceans?  Do we need more throwers?

It is places like the Pediatric Alliance Ontario that we come together, as starfish throwers, to support each other in our daily grind.  We share stories, and reflect on these harder questions together.  Collectively, we try to come up with ways to make sure we care for our patients, on the frontline, on the beach, in safe and sustainable ways, and advocate for cleaner oceans for our starfish.

As an academic Paediatrician at St. Michaels Hospital, Unity Health Toronto, I do have time to pause, take a look at the ecosystem around me, think about my department and reflect on the work we do and the families we serve.  I look into the ocean and I can’t help but see that there must be upstream solutions. Is there something at the ocean level to protect starfish and reduce the amount that end up on shore? Are there more efficient ways to keep starfish in their ecosystems and enable them to thrive?

And then the existential questions come to my mind.  How polluted is the water?  What conditions are we sending the starfish back into? And if we develop a more “efficient” system of collecting starfish in large batches, does this mean only the strongest starfish survive that process? And is that worth more than the gentle care of each individual one that we currently provide.

To be clear – I do not think the babies, children and youth are simple cases of care that pediatricians can “save”.  But the analogy holds that I do think that we are seeing more and more children and youth washed up on our shores who are increasing in their complexity, and requiring individualized, trauma informed care to make it home again.

And also to be clear, the reasons for this storm are not an act of nature or an act of God. The storms that bring families to their doctors are by design.  “Every system is perfectly designed to get the result that it does” (W Deming).  Structural and social determinants of health bring some families to our door more than others.  And even as we send these children and youth back into the ocean, without adequate access to food, shelter, and supported education, they will not have the strength or stamina to fight the tides that send them back our way.

In the meantime, the experience with each starfish, and knowing it matters to them, helps me continue my work on the beach and steadies my gaze to the horizon beyond.