At this place again. 

Place: Neonatal ICU.

Time: 3 AM. 

Location:  Bedside of a sick preterm female.  She is intubated and on the ventilator.  Antibiotics course through her veins. Blood transfusions, IV fluids, and vasopressors support her in the fight of her life.  Lab tests are checked and adjustments are made to meet her needs.

Her parents sit beside her isolette. They watch the monitor, silently begging the numbers to give them some sign, any sign, that she is responding. The doctors, practitioners, and nurses review the vital signs, urine output, lab results, and XRAYs to gauge her response to the medical interventions. 

Lingering overhead is that feeling of …… what if she doesn’t respond?  What happens then? It’s a possibility that no one wants to entertain.

Poor prognosis and death is a difficult part of being a doctor.  Though some specialties confront it more than others, it remains a part of the physician experience.  Medical schools provide a few courses on the subject. Living it is a totally different experience.  Advances in medical research have pushed the limits of viability so that babies born as early as 23 weeks are resuscitated.  Term newborns with diagnoses that were once considered lethal now survive.  The journey of surviving in the Neonatal ICU is plagued with many near death experiences for the newborn, the family, and the caretakers.

How do we as caretakers, take care of ourselves with the uncertainty of a day in the NICU? How do we remain objective, positive, and supportive of one another in the face of caring for a critically ill infant?  How do we keep doing what we are doing with the expertise, precision, and skillset that only those in the NICU possess?  How do we stay focused in the present moment, on this particular little girl, and not think of the sons and daughters who did not respond to therapy and did not go home with their parents?

There are no easy answers to these questions.  Some people advocate for compartmentalization and detachment.  Although that may work for a while, there is the risk of becoming so detached from life that you miss the joy and beauty that life has to offer.

This question is one of the greatest challenges of my medical career. If the oath I took was to do no harm, then how do I reconcile the pain and suffering that parents in the NICU endure when they receive that call to come to the hospital because their son or daughter is not doing well?  What do I say after they have been updated, been told that everything medically possible is being done and that we have to wait to see how she responds to the interventions?

In my search for answers I found the world of coaching.  A world that expanded my definition of a doctor to include healer.  I came to a new understanding that after my role of doctor has been satisfied, I can come out from behind the stethoscope and allow the person in me to connect to the person in them.  I can be a person who understands that a mother and father mourn the loss of their dreams from the very moment they leave their son or daughter in the NICU to get the care he or she needs until strong enough to go home.  I can be a person who shows compassion when they question everything that the medical team is doing, realizing that their trust waivers when progress is slow.  And I tap into being a person who empathizes with their pain when I share all the possible outcomes including the one that will crush their hopes and dreams. 

It is standing in my authentic self that I make peace with the difficult times, the challenging times, and the times that I am not prepared to face.  It is understanding that doctor goes far beyond what I learned in medical school or on clinical rotations.  It reaches into the scope of healer where I connect to patients and their families through humanity, compassion, and love.

Will you allow your authentic self to shine because that is exactly who your patients need?

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