Tuesday, March 30, 2010

Leap of Faith

Standing on the edge of the Cornice at Mammoth, I look at the precipice of the run I’m about to undertake. I watch skier after skier complete their first turn off of the edge and disappear below.  The sun beats down on me. It is a perfect day for skiing.  For the first time in recorded memory the wind is not howling on this ridge so I can take a few moments to look around, to appreciate the beauty of where I am.

Then I turn my mind back to the run in front of me.  A big group has just gone. It is my turn.  I feel my heart beat faster, those few familiar moments of fear as I prepare to drop into the bowl I can’t see.  I trust in my skill on skis, my experience, my strength.  Yet still there is something awesome about having to take this kind of a leap of faith into that which you cannot see.

I take a deep breath, and I drop from the cornice.  The first few turns are so steep, but the snow is perfect.  I gather speed. I can only hear the sound of my skis speeding over the snow as faster and faster I carve my turns.  My legs, my body respond on muscle memory alone.  I am 100% in the moment, nothing else on the mind.  Just this.  At the bottom, I feel the exhiliration the rush of doing something that seems a little crazy.  There is no lift line.  I go again and again, different runs off the top, the same moment of fear, the same exhilaration at the bottom, until my legs scream that they can take no more.

There are days I walk into situations at work that seem so terrible, terrible beyond anything most can imagine.  I feel a similar moment of questioning, of anxiety.  Am I equal to the task placed on me?  I allow myself to question it, but only for a moment that is all that fear gets.  Then I’m calm and collected as I direct the team.  I trust in my training, my skill, my knowledge, my colleagues.  In those moments, my focus is similar, I am 100% in that moment, yet the two experiences couldn't be more different.  It is a leap of faith of a different kind.

Wednesday, March 3, 2010


I am a neonatologist, most of you know this. My specialty isn't all about happy endings and everything coming up roses. We deal with critically ill babies, babies so sick or with such rare diseases that they are transferred to us when they cannot be cared for in the community anymore. We have many wonderful success stories. I celebrate those because they keep me going through rough days. However, we also have many sad, sad stories and unfortunately some of the babies who come to us cannot be saved.

In my professional life, I am equally dedicated to saving the babies in my care who have a chance at survival and doing so with the highest level of skill and integrity that I can, as I am dedicated to not inflicting unnecessary suffering when it is clear that there is no possibility of survival. These dual goals of mine are not at all at odds with each other, but they do require extreme clarity and certainty of your knowledge. You must have the facts and when they are unclear fight for life. When the information is there you must be able to tell the family so they can understand and work towards acceptance. If you are not objective, this is not possible. This is why as physicians we do not care for family members, or those who are like family. Because try as you might, you cannot be objective. I have on more than one occassion wound up having to care for the children of people that I know in real life whether close friends or acquaintences. We have had family members of our staff in the unit etc. and try as you might that objectivity is affected. Which doesn't always translate to better care for the patient which is after all the whole point.  

However, this is not in anyway to say that you should be withdrawn. As a neonatal intensivist, my humanity, my care, my concern is my center, my driving force. I must care, so that I can do my job to the best of my ability. As I have said the day that I do not shed a tear when a baby dies will be the day I quit.  No questions asked, no second thoughts.

I struggle with these issues when life forces me to cross those lines and the black and white that I can normally see all becomes shades of grey.  I try to avoid it, but sometimes I can't.  I just try to do the best that I can and admit my weaknesses.  Wish me luck.