Needless to say, my acquaintance felt terrible. You would feel bad about that even if your patient were a stranger, but to have it happen with a friend magnifies the feeling. His feeling of guilt persisted even after quality assurance reviews found no fault with his actions, and even now, more than a decade later, it was hard for him to talk about. I couldn't help but think, though, that even though the physician's pain was great. the mother's must have been much worse. She not only had the pain of the loss of her child, but she too must have had a fair amount of guilt.
I am told, and have at times observed it myself, that mothers of babies with problems have a lot of guilt, often without rational basis. I can imagine them thinking to themselves, did I wipe myself wrong, causing a bladder infection that set off preterm labor? Did my water break at 26 weeks gestation because I had sex last night? Did I come to the hospital soon enough? Should I have used a different obstetrician? Even though the mother may know in her head that a premature birth, for example, was not her fault, she can still have trouble shaking that guilty feeling.
Like all doctors, I have made some mistakes. When I do, I usually determine to learn from it, or rationalize it, or use some other internal defense mechanism to soothe myself. Time, too, has a way of lessening your guilt. But if a mother feels guilty about causing preterm labor and has a child who is an NICU graduate with deficits, is that a constant reminder of her thoughts of guilt? Or does the rational side of her, the one that knows in her head that the prematurity was not her fault, eventually prevail? Does the joy of her child drown out those guilty feelings? If a child is more severely impaired, are the guilty feelings worse? Do they last longer?
I'm not sure what the natural history of guilt is, and I'm hoping that I don't have so much that I find out. I wonder if it has stages, like Kubler-Ross's five stages of grieving. I think we just have to remain aware of it in mothers' lives, because they don't seem to talk about it much, at least not with me. Maybe it's easier for them to discuss it with the nurses, who are in general less intimidating and almost always female.
P.S. It seems that somewhere in this post there should be a phrase about a Catholic upbringing or Jewish mother, but I just couldn't figure out where to fit it in.