Several months in to my fellowship to become Neonatologist I found myself at the end of a 28 hour shift attempting to place umbilical catheters (basically IVs that goes directly into the umbilical cord of a newborn to direct nutrition, medications or fluids directly to the central vascular system) in a small ~900 gram (just shy of 2 pounds) baby. I had successfully just intubated the baby after a smooth resuscitation and we were stable on our mechanical ventilation, but desperately needed a way to give fluid to the small baby. While a catheter was easily guided into the vein of the umbilical cord, the attempts at placing a second catheter in the artery was trying despite almost an hour of us working away at inserting a small tube millimeters in diameter into a hole that seemed even smaller. To add on to the stress of critical timing and the heat of the room as we were layered in drapes and gowns to keep us sterile, the father of the baby was in the room watching – not a usual situation. As we were halfway through our attempt he turned to a nurse in the background and said, “Wow, this seems like it’s a pretty difficult thing.” Shortly after, we gave up and left with only 1 catheter in place. An unfortunate but not uncommon failure.

There are so many things that we hope when we are sick or go to the doctor or seek medical solace in the 21st century… Primarily, we always assume or believe that we will find an answer to what our question is and find some comfort in the help of an “expert.” When we or our loved ones are sick, we turn to those that heal for help – whether that be eastern or western medicine. In times of not finding a black and white answer or an incomplete solution due to the mere lack of knowledge, we might even go elsewhere or seek a combination of complementary goals. There is always a find line I feel as the healer on the other end when I answer the questions of patients or listen to my friends or family talk about their perspective of their health provider. Trust and knowledge, while possibly with abundant potential, can not exist without confidence, and honesty with sincerity can not be conveyed without transparency.

There are so many things we have the answer to in medicine. The exponential gain has led to discoveries we couldn’t have dreamt up years ago and the speed of technology and information spread is growing more and more daily. But, we do not know everything, and we can not save everyone.

Hope and optimism, while always important to foster in those I care for, have boundaries and it is much harder to break those down in a sympathetic way even if the basis of the “tough love” is from true compassion. I have found in the last 10 years of my medical career that I find myself telling patients often that, “I don’t know” when they ask questions that exceed medical understanding or my own personal knowledge. I have found that I possibly I have become less and less thoughtful that I know very much as I see the world expanding each day. When futility has crossed the path of a patient I take care of, I have been open and honest that I do not have the skills or the ability to continue ensuring the life of the human before me.

It is not, “there is nothing I can do,” but it is that “we have reached the limit of humanity and it is time to accept the universal fate we all eventually come across.” Obviously, a much harder conversation to have when taking care of children. With time, although many have a difficult time seeing my point of view as a seeming conjurer of illness and death, accepting limitations and existence leads to a happier and more fulfilled time on earth, as is my opinion. My limitations have stopped me from being able to cure all disease and have stopped me from being able to save all lives. It doesn’t mean that I am not disappointed when science fails me and my acceptance of these things and my transparent frailty might not always inspire confidence, but it is always important.

That baby survived that day among odds we would not have been able to overcome decades ago. We don’t always know what we do in Neonatology, as we seek to understand the early moments of existence, and it is important that people realize this. In the purest understanding and definition of the field, we dive into the unknown. Evolution has allowed us to surpass limitations like this from time to time, but there are many that still remain.

Image Credit: https://iasbaba.com/2020/11/creative-guidance-knowing-your-limitations-inspirational-educative-articles/