'There are a lot of feelings that come up in this work,' rehab doctor says

Photo courtesy of the Ontario Medical Association

By Louise Kinross

Dr. Alysha Ladha began her journey at Holland Bloorview in 2013, when she trained to become a developmental pediatrician here. She now works with our inpatients and outpatients in our brain-injury program. We spoke about some of the unique challenges of working with families of children who acquire disabilities through trauma or illness.

BLOOM: How did you get into this field?

Alysha Ladha: I stumbled into pediatrics. My first two years I was leaning towards adult medicine. I was thinking internal medicine or neurology, or even being a family doctor who would deliver babies. Then I did a rotation at London Health Sciences in pediatrics, and I fell in love. I realized I loved kids, and I enjoyed working with the families, and the actual medicine of it. People are really thoughtful when they treat kids, and I appreciate that extra thoughtfulness.

I was able to work with children who were admitted for a wide variety of reasons—so there was a really nice breadth.

I was thinking about becoming a pediatric neurologist, but then in clinic I was finding that I had a lot of questions around ‘how is this kid doing in school, and what does their quality of life look like?’ I had some really good mentors who suggested I look into developmental pediatrics. It’s the place where the brain and day-to-day life connects, or intersects, with the focus on function and participation and education, bringing it into a developmental trajectory.

BLOOM: How did you get interested in being a doctor in the first place?

Alysha Ladha: When I was growing up I was told that if you’re smart, and good at science, you should probably be a doctor. But I wasn't really convinced.

In my last year of high school my grandmother had her knees replaced and she went into a rehab facility. I remember going to visit her and she was super stressed out. But then the doctors came by and chatted with her, and she was so calm and reassured, and I thought it would be great to be able to do that for people.

BLOOM: What is a typical day here like?

Alysha Ladha: Most days involve inpatients. I may be checking on my patients on the units, to see if there are any medical concerns, or rounding—which is sitting down to discuss with the team how kids are doing, or wandering room to room to check in. Often a lot of coordination is needed around discharge planning. I may be following up on test results or suggesting medications. Some days I have clinics to see kids who were admitted as inpatients, but are returning for follow-up. I also see kids through our concussion program and have some academic time, for teaching and research.

BLOOM: What areas of research are you interested in?

Alysha Ladha: I’m still finding my way. I appreciate a lot of the quality improvement work going on, and that’s probably something I’d like to pursue in the future.

BLOOM: You spend most of your time with children with brain injury. I think working with families whose children were healthy, but acquired disabilities through trauma or illness, poses unique challenges that are somewhat different from parenting a child who is born with a disability.

Alysha Ladha: Anytime a diagnosis is given, there’s a grieving process that happens for families. Absolutely, what we deal with is so fresh, and it involves so much change for families in that moment when they first come to rehab.

In a lot of cases, that freshness does lead to a specific kind of trauma and stress on families. A big part of what I do is meet families where they are with regards to how they’re coping and what they can do.

In some ways, part of the process of going through rehab helps with some of the trauma. Parents are around other families in similar situations, and some informal mentoring happens. They’re with experienced clinicians, and they have goals to work towards. I think if there wasn’t that structure, things might feel overwhelming. Being in a safe, supportive place, and having something to do, helps people put one foot in front of the other.

There are a lot of feelings that come up in this work. There are times when our social workers ask physicians to do education sessions for youth and families about their brain injury. There can be anger, or tears, and it's important to be present in those moments with people.

BLOOM: How do you build resilience?

Alysha Ladha: I work with a really wonderful team, and we do debrief and talk about feelings and what’s happened with certain cases. It helps to process it. I’m consistently in the social workers’ offices. When there are challenging cases we may have a weekly team meeting update. There have been requests for us to do more formal debriefs, and I think we’re going to see more of that happening.

There’s also a lot of happiness here when we see kids achieve different milestones, or when parents take their kids home on weekend passes, and that goes a long way.

BLOOM: What’s the greatest challenge?

Alysha Ladha: I wear a lot of hats: My medical hat, my case-coordinator hat, my nice-person hat. Sometimes I wear other team members' hats, depending on who is around and what’s needed. There’s my educator hat, my academic hat. Sometimes balancing all of those can be challenging, and I really try to prioritize where the biggest need is for my time. Most people who go into medicine like being able to fix things and solve problems, and sometimes there isn’t a good solution. We need to be comfortable with that, and be able to communicate that in a way that’s supportive.

BLOOM: Greatest joys?

Alysha Ladha: Celebrating the little moments of change. Seeing families—and children—grow and build confidence in themselves. I love hearing the kids announce lunchtime over the PA. They get so much joy out of it. They have so much character, and it makes my day.

BLOOM: Do you do anything specific to manage stress?

Alysha Ladha: I’m a talker. I debrief with my teams to process things. I have good family and support from friends. I’m been good recently about going to the gym. I’m doing yoga and pilates and barre. And I sing.

BLOOM: Yes, I heard you sing with the Mendelssohn choir.

Alysha Ladha: It’s my side gig. My Grandma used to sing hymns, and she looked after me. As soon as I could speak in sentences, I was singing in the mosque. I did choir growing up and right into university.

It’s a huge stress relief to just sing things out. I have a sense of community there, and being part of something bigger than myself.

BLOOM: Did you have a personal connection to disability?

Alysha Ladha: I grew up in a very tight-knit community and there were people who had visible disabilities there that were part of the community. My first big exposure to disability, though, was a rotation in general pediatrics. I found this was a population I really enjoyed. A big part of why I do disability work, and what I communicate to trainees coming through, is that these children have a whole life outside the hospital. What you see when a child is acutely unwell is usually not what their day-to-day life looks like.

BLOOM: If you could change one thing about children’s rehab, what would it be?

Alysha Ladha: There’s a lot of great work being done around the F-words of disability: function, family, fitness, fun, friends, future. I think there’s still a huge perception that more is always better—in terms of therapy. If all a child does is go to appointments—and we see it—they’re not getting to live their life. Sometimes the messaging that they always need to work on something can take a toll on their self-esteem.

It would be wonderful if we had a more objective way to be able to say when a child does need more intensive rehab, and when a child needs to be involved in their community, and practising their skills there. Something I’m seeing a lot of now, too, is group-based therapies, and I think they can be wonderful from a service-delivery and social standpoint—for kids and for their parents to network.