*Details have been changed to protect privacy. Written to honor, revere, and remember those who give me the privilege of being part of their story. Written to pay tribute and legacy to those that Play to Win and those that need someone to Play With Them.*
“[They’ve] done well… But we’re worried that when [they] comes off of [life support]… [They] 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 [life support] to see how they’d survive on their own… Just a few weeks ago, late into the night I had sat at the bedside, talking to the father about the plan of care, the plan for the night, and the inevitability of Life or the end thereof. Their child had a difficult beginning, and we knew the road ahead would be long and uncertain. 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 where we were, he questioned, “Why are my here?” just as many of us do, for a multitude of reasons at various junctures. Then, his child found himself at our facility, and shortly after required extensive interventions and [life support]. Everything after that, to Me, as one of his Doctors, was a blur. He required a long [life support] course and we had reached a point after multiple trials of trying to help his lungs grow and mature, of trying to finally come off and see how we did without the machines. 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, recollected that day as we discussed removing his child from the life-saving power of [life support], “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 child, and then told us about the way he would give pep talks to his 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 game when you’re down 1 to 7 in the last quarter or inning, that it is still not time to give up.
Our 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 transitioned off of [life support], successfully, a feat none of us (providers, healthcare team, family) thought was possible. Unfortunately, the child endured a very strenuous course over the nexts several months. However, ultimately, their condition was so significant that as they grew, their lungs did not. Then, one night, after playing their 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 Coach over the course of several months, I will Play to Win.
