Once upon a time, as a resident I was rotating through the NICU (Neonatal Intensive Care Unit) and we were called to a delivery for a preterm baby – it must have been around 28-30 weeks of gestation (2-3 months early). The resuscitation was smooth and as expected, needed a little bit of oxygen and some warmth, but overall didn’t have any significant issues. We went straight back to the NICU, where our new little friend needed a little more oxygen (nasal CPAP) and started having episodes of apneas, bradycardia and desaturations – basically common premature problems of forgetting to breathe – and, as we had expected, needed a little bit of caffeine to remind him that breathing is important. He was a fair size for his prematurity but still small enough to need some nutrition through an IV in his umbilical cord as well as a tube in the mouth to give breast milk directly to the stomach because he was going to need some time to learn exactly how to eat, also a common problem. As we were getting settled through all of the initial routine stabilization steps we took a chance to do a full exam and to our surprise found ourselves with a curious case of polydactyly – there was an extra little finger on both hands and both feet – four in total; but, he’s forgetting to breathe, let’s start with that.
Well, after the commotion had calmed a bit, the mother and father came to see their baby. We discussed very gingerly our concerns over his prematurity and how our biggest hurdles were watching out for infection, slowly slowly growing with gentle feedings and of course, the whole issue of breathing. We spent much of our time and explanation on the breathing. Believe it or not, breathing is one of the most important things one needs to do. We spent much of our time and explanation on nutrition and our goals to grow hopefully 1/3 of an ounce per day through IV nutrition in the umbilical cord and feedings into the stomach that would be increasing at a rate of single-digit-milliliters each day.
We sat for a moment, the parents seemed to be understanding the situation, and despite our trying to impress the importance of prematurity, things we could handle but still things to watch with caution, all they seemed to ask about was: So what about the extra fingers and toes? Do we get the removed now? – It was the most important thing to them; but, for the baby, he was just trying to learn to be alive.
Fast Forward. Recently I had a baby that had a difficult time adjusting to being born. She didn’t want to cry for me right away and needed a little help being reminded that she was born and had to take her own breaths now. After a couple of minutes of our routine resuscitation steps, she decided to participate, started breathing on her own and soon after was ready to be held by mom. I could hear with my stethoscope a common issue that many new babies face of having a little extra fluid still built up in her lungs, but knew that as she cried she would likely improve all on her own. Surely enough, in a couple of minutes she was a perfectly well, healthy little baby; until, surprisingly at 24 hours old, she had a bilirubin level (a measure of how jaundice or yellow the skin turns) that was unexpectedly high. I quickly put her under blue bilirubin/phototherapy lights where she enjoyed a warm little tanning bed for a couple of days. Finally, her levels came down and I turned off the lights, watched her for a little bit longer and then prepared to send her home.
After a few days of being our guest in the hospital, I found myself giving the usual counseling/education to this brand new first time mom and dad about care for her baby and explaining signs to watch out for. Dad chimed in from face time: Doc, is there anything we can do about the fluid in her lungs? – I had stopped thinking about this days ago shortly after birth to be precise, her bilirubin was the only problem I worried about.
A couple of days ago, I went to examine a routine healthy well-baby. Nothing was wrong. I placed her back in her crib, asked mom and dad if they had any questions or concerns – this wasn’t their first baby but I couldn’t read their emotions or what they were feeling. They were quiet, just watching me, just listening. As I left the room: You hold our baby so gently, Doctor. When our other babies were born in the NICU, they were just throwing them around it seemed. Thank you. – I know this was an exaggeration, but the smaller a baby is, the more fragile we think they are and the easier it is to perceive that handling them is rough. I know the NICU they spoke of and as a provider, I have had wonderful experiences with their staff and always felt reassured and comfortable when I’ve needed to transfer any of my troubled babies to them for more help.
I chose Pediatrics for many reasons, but the hawk eye of parents on my every action, my every move and every single word that comes out of my face has been one of my more curious favored challenges. It is easy to get caught up in doing what I’m doing or saying what I’m saying; I do and say the same thing every day. My prerogative and what I focus on, with good reason in my opinion, are things that I view as medically important and, uh, life and death.
But, one thing that becomes increasingly curious to myself the longer I practice is Perspective. I learn everyday of the interesting things that Parents and families fixate on. The perspectives of what matters is so often much different than what I see. I learn with every Parent how to view as a Parent, and what ACTUALLY matters. As a Pediatrician currently and possibly forever without children, I learn only vicariously. Empathy, through the shuffle of busy days and repetitive protocols, sometimes becomes lost on myself. Yet, even in more serious cases, among a team of doctors and nurses, we collectively hear questions and statements that catch us totally off guard. As a doctor, fingers and toes are less important than breathing. As a doctor, some problems are transient and the words ‘acute’ and ‘chronic’ define where I triage my decision-making skills in real time. As a doctor, I’ve held hundreds of babies and know that most of them are not as breakable as you’d think. But, as a parent, what matters is worlds different. Listening to the things I say and watching the things I do from the other side will always be interesting to me.
I’ll never forget placing that little baby back in the crib, and those parents saying thanking me for being so gentle… To be honest, I was just trying not drop her 😅.
Happy Mother’s Day.