Monday, February 20, 2006

Recriminations

I hate it when a baby dies. I hate it for all the usual reasons: because no one likes to see a cute, innocent baby die, because you know it's not just the loss of a human but also the loss of the parents' hopes and dreams, of a father's dream of teaching a child how to pitch a baseball, of a mother's dream of putting ribbons in her hair and taking her shopping for a prom dress. I hate it because the parents are crying, and the nurses are sad. I hate it because you wonder whether you were inadequate as a physician.

There are more mundane reasons for not liking it too. There's the frustration of filling out a death certificate, knowing that you'll be called by the funeral home in a day or two to complete another one because our hospital always loses the original one. There's the awkwardness of asking the parents about the body's "disposition." Do they know what funeral home they would like to use? Do they have money for a funeral? Would they like an autopsy? Do they know what an autopsy is?

But the thing I hate the most are the recriminations. It's not so bad when a very premature baby dies shortly after birth because he was simply born too early. Not to sound callous, but those are just a fact of life. We have limits as to how early we can save a baby and all the staff understand that. But when a baby lives for several weeks or months and then dies, there are always some accusations that quietly make their way around the unit. The baby should have been on antibiotics. The baby should have been transferred earlier, later, or not at all. The nurse shouldn't have done this or that. The normal comradery and team feeling of the unit are temporarily damaged.

It is, I guess, a natural reaction. People have become attached to the baby and express their frustration. And fortunately the recriminations don't last long before the unit gets back to the job of thinking about, and caring for, the living.

6 Comments:

Anonymous Maya said...

The dreams of the parents were a bit stereotypical. But a good post otherwise.

9:03 PM  
Anonymous Chris and Vic (CAK) said...

Neonatal Doc, you talked about many facets of death . . . but not all. Some people who have strong religious convictions remember the lines from scripture (the Bible) that say: I have set before you today life and death. Choose life. (paraphrase)
I think we have an instinct to choose life, to protect life, to prolong life, and to grieve when life ebbs away.
Having been present when life ebbs away in the NICU, I often wish we could stay with our grief a while longer, to learn from it, instead of having to jump-to and deal with the next infant in line. Grief needs time to play itself out. There are stages of grief, pointed out to us by Elizabeth Kubler-Ross and others. But like the rush that we are all in at this time in history in our culture, we similarly rush through grief, being impatient with its gradual
nature.

In the NICU and elsewhere, it is good to get off the treadmill, to thumb our noses at the fast-paced environment of the NICU (and the culture in general). I think you should be paid for your down-time, from the post on Money. Your down time is time to process and evaluate and it is entirely necessary in order for you and me to carry on in medicine.
Chris and Vic (CAK)

9:35 AM  
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