I was asked several weeks ago to write a blog about the perspective of a neonatologist, once a baby dies. It’s taken me almost 4 weeks to actually write it. Unfortunately I have plenty to share about the subject. I have stood at one too many baby’s bedside while they took their last breath. I’ve held one too many mother’s hands as she cradled a tiny fragile little body. Stared into the glistening eyes of one too many father’s trying to hold back tears. And certainly I’ve stepped quietly into the hallway on more occasions than I care to recall to shed my private tears and to scream my not so private and not so nice words. Probably the hardest memory of all is standing quietly in a baby cemetery watching balloons float quietly away over tiny headstones. Headstones covered with toy trains, dolls, teddy bears and little cars and trucks. Have you ever visited one…it’s unreal. But even with all of that it was still so very hard to write this piece.
Its crazy I know, but doctors, nurses, health care providers—we don’t like dealing with death. I repeat we hate any part of death, beginning, during or after. Yes we are in the business of care-giving and we do understand that not every patient will survive. However, I am confident that most if not at all of us when we applied to nursing or medical school did not write on our letter of intent….I want to become a physician or a nurse because I want to watch patients die…and in my case…babies die. I recently attended a conference in which one of the speaker said death is not an elective it is a part of the core curriculum…we all must learn to deal with it. I thought…yes that’s it..we all must learn to deal with it…but do we really? How does that? And even though I am passionate about neonatal and perinatal hospice…I still ask, “Did I do okay? Will the family be okay?”
I can think of several times I most certainly did not learn to deal with it…. I remember attending the funeral of one of my favorite patients and families and while still in training. The baby had been born extremely premature and died at almost 2 years of age after a long and complicated course with problems related to maturity. The mom literally asked me if I was ready to say good-bye, because the family was ready and they were worried about me. I attended the funeral and became so overwhelmed with grief that I had to leave in the family car. Incredibly, hours later my secretary had to go and get my car. At the time she said, “Dr. Kincade you have to get it together. You are not family. You DO NOT LEAVE in the family car!!” She was so very right. But deep down, really deep, I did feel like family.
I remember loosing several older patients during my oncology rotation for pediatrics residency. Many had decided they were ready to die and did not desire further chemotherapy. This was hard for me, because it didn’t’ mesh with my view at the time of saving lives. I now understand that there are outcomes worse than death and that choices matter so very much at the end of life. One of the parents noticed that I was struggling with the decisions families were making and referred me to the hospital chaplain who then referred me to the employee support group. At the time I was quite offended and said,” I am coping well. It’s the families that aren’t coping! Who sent you to me?” “One of the families the chaplain said! “ With that. I started crying and I went to the support group, he was right I needed to be there.
It’s strange reflecting on this during Prematurity Awareness Month. Because I am all too AWARE EVERY MONTH of the number of preemies that do not survive and the precious families that love them. They are not just ribbons, they are truly losses, babies with names, sons, daughters, ten fingers, ten toes and all the special things that make us love these little human beings that we call babies so much.
So when asked how this physician copes with the death of a baby I share the following: It’s slowly. One death at a time. One family at a time. One breath at a time. One heart beat at a time…and a life time of what if’s..why this family…and maybe next times. Some hugs. Lots of prayers. Many tears. …and sometimes riding in the family car.