The surgeons called us into the room as we were finishing our sign out from day to night at shift change. It was around 5PM and I was about to start a long 16 hour night shift, always a little unsure of the unknown situations I might face. When we walked in, everyone was dressed in sterile gowns, and a small 3 pound baby was lying on the radiant warmer with surgical drapes covering him. His abdomen was still open as the surgeons gingerly examined his insides only to find that more than 90% of his intestines had died. He was inoperable, there was nothing they could do, there was too much necrosis, so they closed him back up and left to speak to the family – necrotizing enterocolitis totalis.

One of the worst diseases to befall premature babies in the NICU, since the birth of Neonatology, necrotizing enterocolitis has become an entity that, despite decades of scientific research, we have only gotten slightly better at preventing. A massive surge of infection/inflammation of the intestine that is often hard to diagnose without surgery and often impossible to prevent, leads to decreased blood flow to parts of the intestine, and when this happens, as things do, it dies. This cascade of injury can lead to parts of the intestine wall becoming weak and developing perforations that seep bowel contents into the rest of the abdomen worsening the cycle and can quickly lead to irreversible damage. For the lucky, surgery isn’t needed and with “bowel rest” and antibiotics recovery is possible. For the unlucky, surgical removal of parts of the intestine is crucial for life. But, for the devastated, too much of the intestine is damaged and recovery is nearly impossible and even if attained, leads to a complicated life with the prolonged potential of suffering and an early end. In the case of our baby that night, he was dying, and science had met it’s limit.

I remember sitting in a small room away from the patient’s bedside with my attending talking to the family about our grim situation as we discussed that it was time to consider limiting what we deem in medicine as “heroic measures” – Do Not Resuscitate. We discussed that despite maximal medical therapy and treatments, we could not reverse the devastation that this fragile baby had developed, due to nothing but bad luck. This wasn’t the first time I’d had a conversation as dramatic, but it never lessens the gravity for me. He was going to die – we didn’t know when, but we knew from many before him, we could not stop it… His father listened quietly and after some time asked through shaky tears a question I hadn’t heard before:

“… Can he be a donor? If that much inflammation is going on, we want to try to make sure we can talk to the transplant service before it gets to the rest of his organs… I want him to be able to do something good for this world, to have an impact.“

Wow…

When I chose to become a Pediatrician and later a Neonatal Intensive Care physician, many people would say to me, “But why? You have to deal with the parents.” No, I have the honor and of working with them. I am given the privilege of seeing Love at it’s finest. It is possibly the single best part of my job. For years I have noticed and observed parents and families around me. From my closest kin to a stranger on the street, from various parts of the country and the world, and from cultures that are seemingly opposite mine and one thing has always been clear: parents will do anything for their children. Yet, a second focus has overtime become more and more clear to me: they also want their children to leave a legacy, just like them.

In high school I will never forget when James Shee gave his valedictorian speech, something that was reverberated for years following. We went to a Jesuit school and he echoed the words of St. Ignatius of Loyola that have since found a way back to me time and time again, “Go forth and set the world on fire.” The depth of the impact we make will likely not be understood in our lifetime, but the longevity of the ripples is infinite. I have seen parents move mountains for their children and I have been witness to the most vulnerable points of humanity – it never ceases to amaze me what Humans are capable of doing, feeling and thinking. In these most delicate ethereal times of life, the depth of who we are glimmers through the darkness.

Medicine has always been a Calling, but it is always esoteric as to who is actually making the Call. Understanding humanity and finding the root of purpose has been a philosophical journey we all endure. Every patient and every family I have ever come across has left their legacy with me, every birth and death has etched marks on my heart, and every moment like this has deepened the Call.

As the night went on, his heart beat slowed, his blood pressure became undetectable, and we removed his breathing tube so he could be held by his parents. He went gently into the night, but will never be forgotten.

Image Credit: ChatGPT