“He’s done well… But we’re worried that when he comes off of ECMO… He may not survive…”
“Man, you really sure you want to do this [be a Neonatal Intensivist]?”
“Yes, every, damn, day.”

It was a Friday, and I was seated across from a couple in love as we discussed our upcoming attempt to take their baby off of ECMO (extracorporeal membrane oxygenation, a.k.a. “heart-lung bypass”) after a long several week run for a severely critical congenital difference… Just a few weeks ago, late into the night I had sat at his bedside, talking to the father about the plan of care, the plan for the night, and the inevitability of Life or the end thereof. He told me that it had actually been a plan (or maybe his parent’s) that he himself go to Medical School. Humbly privileged enough to receive an undergraduate education at a well-respected college in the midwest, the science got difficult and at some point he chose a different path – a path that had created a lifetime of happiness, introduced him to the love of his life, and brought him, somehow, to Kansas. Being told early on in the pregnancy that they were expecting to have a child with a likely lethal prognosis had brought their hearts to a standstill months prior to our meeting. But, there we were, and there was no turning back.

He told us of how his wife and him had discussed and planned their life and moves many times, and at some point after ending up in Kansas, he questioned, “Why are my here?” just as many of us do, for a multitude of reasons at various junctures. Then, his son was born at our facility, and shortly after required ECMO – a sign that his lung underdevelopment was so severe he would likely not survive on his own. Everything after that, to Me, as one of his Doctors, was a blur. He required an especially long ECMO course (not a good sign) and we had reached a point after surgeries and multiple trials of trying to help his lungs grow and mature, of trying to finally come off of ECMO. It was time to bite the bullet, it was time to see if he could survive on his own. A machine, after all, is only and always a machine, a temporizing measure, and the longer we stayed on it, the more things got complicated and the less likely he was to come off of it at all…

As the father, a college baseball coach, recollected that day as we discussed removing his son from the life-saving power of ECMO, “A hundred people have walked through the door. A hundred people have tried to do everything imaginable for hours, days and weeks. You have helped us live a story everyday.” He told us how much he appreciated the blood and sweat each of us had put into this attempt at what he recognized was a Hail Mary to save his son, and then told us about the way he would give pep talks to his college baseball team in tough situations or at any game. “I tell them, we don’t play to lose. We play to win. No matter what. We play to win. So, let’s fucking go.“

He told us at that family meeting that afternoon that everything made sense as he sat there with us. Everything that had led him to that moment made sense. He was meant to be there and we were meant to be helping his family, and there would have been no other way it should or could have played out. As he and his wife wrestled with the questions of mortality and the changes we could fail and they could lose their child, he was both optimistic, realistic and encouraging to the entire room, “Let’s. Fucking. Go.“

As a Fellow Physician in training, I was given the privilege by my Attending to lead this conversation. I was given the privilege to discuss the worst outcome and the chance to sink into a level of vulnerability the few people will ever come across in their entire lives. The father had well understood my role, as a Physician at the bedside, but also as a Trainee learning from his dire situation and it was humbling to be given his grace in such a time. He made it clear that when the odds are stacked against you, just like in a baseball game when you’re down 1 to 7 in the top of the 9th, that it is still not time to give up.

The entire intensive care unit loved his family, their patience, their optimism, their perseverance, and their kindness even in times of turmoil and angst that isn’t possible to put into words. That evening after a long joint-discussion in shared decision-making, we discontinued ECMO, removing the giant plastic tubes that were in his baby’s neck helping to circulate blood and keep him alive…

He came off of ECMO successfully, a feat none of us (providers, healthcare team, family) thought was possible, but endured a very strenuous course over the nexts several months including placement of a tracheostomy; however, ultimately, his condition was so significant that as he grew, his lungs did not. Then, one night, after playing his heart out at the top of the 9th quarter, the 3rd out was thrown, and the game ended.

I have often questioned my own mortality and the consequences of the feats I attempt as a Physician. I have seen miracles and i have seen disasters and there are many times that I recognize very viscerally that my knowledge or technology will not win at the end of the day. However, against all odds, no matter what, as I was taught by the baseball coach over the course of several months, I will Play to Win.