Friday, July 14, 2006

Misfortune

I long ago reconciled myself to the fact that I make my living off of other people's misfortune. I rationalize it to myself by saying that I don't really want babies to get sick; I just want them to come to me if they are sick. Yet, somewhere deep in my psyche, there is part of me that probably does want babies to get sick. Otherwise I wouldn't have a job.

I am reminded of the time in medical school when I listened to a very abnormal heart for the first time. The elderly patient had an artificial heart valve, and his heart wasn't working too well. When I put my stethescope on his chest, instead of hearing the usual "lub dup, lub dup" sound of a normal beating heart, I heard "whooosh pop click, whooosh pop click." I almost wanted to say out loud, "Wow, cool!", because that's how I felt. The elderly man's misfortune was an exciting moment for me, but he probably didn't think it was too cool to have that bad heart.

The other night on call I went to the labor and delivery area to see what was on "the board", a list of the women in labor, to see if there were any potential NICU patients. We were busy and didn't really need more patients. I scanned over the list and came across one who was premature. I started to frown, but wait, there was an IUFD sign on her spot. Before I could catch myself, I thought "Oh, good, it's an IUFD." I immediately felt bad, though, for thinking that, because IUFD stands for intrauterine fetal demise. She was going to have to deliver a stillborn child, a terrible thing for anybody, but not something that would involve me. It seemed like a sick thing for me to be glad about it, but I couldn't help it, because her IUFD meant an easier call night. If she had a live premature baby, it might have kept me up that night.

It can be a weird business sometimes.

13 Comments:

Blogger The Incredible Rag said...

I just happened across your blog and I really like it. My girlfriend is Pre-Med Biochemistry at Ithaca and believe it or not she wants to be a neonatologist.

I was a military cop for four years so I have a trace of an idea of what you mean. I remember the first time I responded to an attempted suicide. I was surprised at how I was more excited to do my job than I was sorry that this individual felt that trying to kill himself was the best option.

I suppose desensitizing yourself is often the best way to get through the day without becoming extremely depressed.

11:45 PM  
Anonymous Ellen said...

I can SO relate to this...I'm a NICU nurse and had the exact same thing happen to me the other night...seeing a demise on the board and being relieved it wouldn't involve us. Nothing profound to add or say...just a "Yeah, totally."

3:21 AM  
Blogger Flea said...

Like Ellen, I can relate to this too. It's human nature, unless you really really like immersing yourself in unpleasantness and misery. If you did, you'd be in the wrong profession.

As long as there are premies I suspect you'll always be needed. Amos Grunebaum of Roosevelt Hospital in NYC wanted to make his life's work the elimination of premature births. That would put you guys out of business. The good news for you is that in principle Grunebaum and his descendents will likely never succeed.

Gen peds, on the other hand, really does live and die on throats and ears, most of which to not require office visits. We embrace these patients when we see them, rather than turning aside, because we want to help them, but also because we need to stay in business.

If all of us reoriented the way we teach pediatrics, practice pediatrics, and educate parents, the MD-level general pedie might well go away (this is what I was alluding to in the previous comment). This would not necessarily be a bad thing.

best,

Flea

6:41 AM  
Anonymous Anonymous said...

While honest, this aspect of the human spirit saddens me. With friends who have been that mom on the board with IUFD written next to their name, I know they would never want to hear anyone got pleasure or joy in any form from seeing it.

8:34 AM  
Blogger That Girl said...

Totally natural. This is why people in certain professions tend to stick together because they are afraid of "outsider" condemnation.
I see at least 1 fatal car accident a day and, except for the exceptions, I am mostly annoyed that these people have made a problem for me (rather than reflecting on the sadness their death has no doubt left behind).
Anonymous aside, there is a big difference in personal relief or gladness and actual joking or innappropriate/hurtful behavior.
I recently had to reprimand my boss for ignoring a good suggestion re:traffic safety because "if less people crash then we wont be needed as much" (he's a real winner).
But becoming used to your working environment as normal when it is bizarre or tragic to individuals is normal and healthy.

11:06 AM  
Blogger Dream Mom said...

Oh boy, I don't feel so well now. I would hate to think Dear Son's docs would prefer he died to taking care of him and keeping him up all night.

On the caregiver side, I am pretty good at defining an emergency and try to be respectful of physician's time. Sometimes, it's hard enough to page someone but if I knew the doc felt that way, I would probably find another doc. Of course, I'd have no way to know that.

We know that there will always be sick babies and sick people who need help even if we would like it to be otherwise. I would have thought the joy of the profession would be saving babies lives not being glad they didn't make it so someone could get some sleep.

12:01 PM  
Blogger Fat Doctor said...

I feel the same way when an ER doc calls with an admission to my service, then calls back to tell me the patient took a turn for the worse and is going to the ICU. Bad for the patient, but good for me. We can be pretty selfish, but I think as long as we take good care of the patients who do wind up under our care, that is OK. We're only human. Don't be too hard on yourself.

12:20 PM  
Blogger WendyLou said...

I'm a child welfare social worker, and I have similar thoughts. I thrive on helping the most seriously abused children. One of the reasons I go to work is that I can make the lives of child abusers hell. I too get excited when I am handled a very challenging case to work with. In a sick way, the worse the abuse, the more professional satisfaction I get from the case. I think part of that is that the harder cases require my "A game" while the more routine cases don't. While I give each case the attention it requires, not all cases require the intensive services that others do.

I also love the days when everyone handles their own problems and I can get some paperwork done.

Don't beat yourself up. Years ago, there was a huge bruha when EMT's were photographed carrying a body out of the canyon, and one was clearly laughing. I know he was just coping and trying to deal with the fact that he was carrying some one's body down the mountain. Others who have not been in these fields don't understand how we cope with the tragedies that fill our professional lives. Graveyard humor has its place. I also feel that for those of us who are overworked, relief that a case is not headed our way is as normal as graveyard humor.

6:08 PM  
Anonymous Ellen said...

I just need to respond to anonymous. I did NOT take pleasure or joy from someone's excrutiatingly painful, unimaginable loss.

We had been having an insane evening in the NICU, and when I saw a new woman show up on the board in L&D at the number of weeks gestation tht she was at, I simply did not know how we were going to manage. Then I saw that it was a demise and, while I'm not proud, my first reaction was relief. This was immediately followed by saying to a coworker, "How sad...to have your hopes and dreams crumble...I can't even imagine how that family is feeling right now."

I don't mean to take over Neonatal Doc's blog here, but there is something very surreal about one's job involving life and death...and how the practical and the mundane overlap with the deeply profound.

If your friend was the woman on the board at my hospital (and I know she wasn't, but let's just say...), nobody from my unit took PLEASURE from her pain. My heart truly hurt for her and I prayed for her. The relief I felt was over the depersonalized fact that we would not be receiving a new admission, because I knew that we simply could not accomodate a micropreemie with our staffing in that moment. The relief was not that your friend's baby died. There's a big difference.

11:13 PM  
Blogger Trax said...

Dream mom...of course it is our joy to take care of sick babies and help them survive. I have been a nurse for almost 20 yrs working in the Pediatric ICU, Pediatric Cardiac ICU, Neonatal ICU and also running ECMO pumps (heart bypass) on kids. The people in our profession don't just do this for fun, we love it, we love the kids, the families, we love seeing them getting better, there is no possible way that you can do this without loving what you do, it is tooo hard just to do it for the sake of doing something at all. You have to depersonalize some things or you go insane, can you imagine what it does to your psyche to see so many kids die. When I worked in the Pediatric Cardiac ICU, we would lose about half our kids...it was horrible, I was having nightmares and felt the extreme stress of working there. I had to quit, I couldn't handle it. Luckily, there are others who could take my place. If we personalized every single child, there would be no one that could fill my shoes when I couldn't handle it because we'd all be nuts from the horror of it all. The reason we lost so many kids there is because our hospital would take a lot of kids that other hospitals wouldn't even attempt to work on, they would tell parents there is no point, and I have to wonder which is better, letting them die like that or coming to our hospital, giving them a slim to nil chance and watching them suffer endlessly. Anyhow, I couldn't take watching it and have since transferred to the NICU where we have a much higher success rate. I still see kids die, it is hard, harder now that I have my own children, it seems every child suffering, dying is my child lying there....tough stuff. Luckily, I am at a point in my career where I don't work that much and don't have to take care of the real sick kids and luckily there are nurses and doctors who do and can handle all that they see. If you do not work in the medical field, it is hard to understand what we go thru, what we see every day....you can not explain it unless you live it. I hope you know that the people taking care of Dear Son care tremendously for him, otherwise they just wouldn't do it. Good luck to you with Dear Son and remember that the doctors and nurses who take care of him are only human.

3:01 PM  
Blogger neonataldoc said...

Thanks, everyone. I'm glad to see that I'm not the only one who has these feelings. We're not proud of them. We recognize they are wrong, but we cannot help them. Dream mom, I doubt that any doctor would consciously wish your son to die, but we have involuntary thoughts that come into our heads before we can stop them.

Flea, I think we'll always need pediatricians. No matter how well we try to educate parents, some of them won't get it right.

12:29 PM  
Blogger Jordan said...

I think everyone in health care has had these kind of thoughts. Sometimes life gets bad enough and we turn to self preservation. these are self preserving type thoughts. You need them to survive!

1:51 PM  
Blogger MK said...

How very sad and insensitive. I truly can't believe there are doctors that think the way you do and then go online and publicly, albeit anonymously, record those thoughts. My son died at 5 weeks in the NICU. I hope to God you never treated him.

11:24 PM  

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