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However, this is not in anyway to say that you should be withdrawn.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.


Jabulani said...

I wish you all the best!

I understand this conundrum. As a parent of school-going children, I want the best for my children, End. Of. Story. Even if that means that your kid goes without, ok. So sue me...

As a School Governor, however, I realise that, actually, we have to aim for the best for all children, and sometimes, that might come at the cost of one of my kids. That's when the sucky really starts. In one of the Star Trek movies (I think No. 2), Spock sacrifices his life for the benefit of the crew. He says: "The needs of the many outweigh the needs of the one."

There have been meetings when we've had to make decisions with which I am at conflict. However, the trick is in understanding that, ultimately, you've made the right decision.

And tears are good. They show you have not lost your humanity! They also wash away the crap and clean up the objectivity. :)

Anonymous said...

I wish you luck every day!