Just another day at the office

He has creamy pink skin.  Rosebud lips. Ten tiny toes, ten tiny fingers. A covering of peach-fuzz hair on his head. He is loved.  His room is waiting at home for him.  He is 7 and a half pounds of glorious perfection.  

Except for the brain damage.

She's standing at her son's beside gazing down at him. She is sore and slow and tired, with her swollen post-partum belly covered in sweats.  Her husband stands stoic beside her.  They don't know what went wrong.  He was fine, fine, fine on ultrasound just days ago. They have just finished a conversation with the nurse practitioner covering her son's care that day.  It's not good, but it's not the WORST either.  He's got a chance. We'll have to see how he does once we finish the cooling protocol and do an MRI.  Then the real waiting begins. It might be years before we know what he's going to be like.  Able?  Disable? Walking?  Talking?  Deaf?  Blind?  Who knows.  We left our crystal ball at home today.

She's standing at her son's beside gazing down at him.  He is still.  So still.  He has tubes and wires coming out of every which way.  The amount of technology surrounding his bedside looks like it could control a missile and is equally formidable to anyone who doesn't know it's purpose. His nurse (my colleague), offers his mom the chance to do his bath.  You know, something totally normal, if she didn't have to work around the breathing tube, the umbilical lines and the urinary catheter.

His mom begins to cry.  As tears roll down her cheeks she wrings her hands and manages to choke out, "I'm afraid I'm going to hurt him!"

I'm going about my day, trying to mind my own business while charting on my patient, but standing 3 feet from her, I can't help but hear everything she says.  My dead baby mother's heart responds so keenly, as I know what she is REALLY saying.

I'm afraid I already hurt him.  I'm afraid I've killed him, or damaged him beyond repair.  He's broken and it's all my fault.

As a nurse I could tell her "it's not your fault" and really mean it.  She did nothing wrong.  It was an accident. Nobody meant for this to happen.  Not the midwife, not the pediatrician, not the doctors, not the nurses, not her husband, not the baby and certainly not his mother.  But I know, she will blame herself...we always do.

A few days later he is breathing on his own.  Learning to eat from a bottle.  He will have challenges, but he will go home.  His mom is holding him and she looks a little better.  At least she smiles back at me.

He is one of the lucky ones.

Another day, I'm over at the fridge.  Searching around for the containers holding my patient's breast milk so that I can draw it up into tiny syringes to push down the tube in his nose into his stomach where it will hopefully stay to be digested and not end up back on my shoes.

I look over into the room next door.  The lights are dim, even though it's the middle of the day.  The staff doctor is speaking quietly to a couple sitting in matching rocking chairs by their son's bed side.  They are absolutely still.  I can tell just by their posture, and the blank looks on their faces that it's not good.  His nurse leans over to me and whispers, "she's talking to them about withdrawing fluids..."  They have already been told their son is beyond hope.  Unlike other organs which can recover from a lack of oxygen, the brain cannot.  His death certificate will read asphyxia.  Withdrawing fluids will help to not prolong things.

Withdrawal of fluids is completely appropriate in this case.  It is only offered in situations for which nothing can be done, and the family has agreed to a DNR.  But as I stand there watching that couple hear a doctor speak so calmly and plainly about hastening their son's death, I remember what it's like to get that news.  Nothing can be done.  No hope.  Beyond saving.  Might as well end it now.  It hurts.  Hurts like a gut wound.  You feel your stomach dropping out beneath you.  You feel dizzy and sweaty, like if you could only just block your ears, your mind, your heart, maybe all this awfulness will just go away and leave you and your family alone.  But it won't and it doesn't.

I look at the parents.  They are so completely, totally ordinary.  A month ago she was probably at her grocery store, or in the mall, or at church or at work, getting belly pats from well meaning old ladies chirping "oh, looks like it's any day now!"  She likely smiled and then rolled her eyes as they walked away.  He probably assembled the crib and attended birthing classes feeling like a fish out of water.  Worried about being a good enough dad, and maybe even rubbed her feet after a long day.

A month from now she will be back at that grocery store, slowly walking down the aisles.  Avoiding the one with diapers and wipes and formula, because even though she was going to cloth diaper and breast feed, it's all just too big of a reminder.  He will be at work, shooting the shit with the guys...but breaking a bit inside when colleagues mention their kids.  He'll quickly look away and busy himself with something else.  This year won't be what they thought it would.  No camping trips with an infant.  No holiday parties with the 'grandparents'.  Just them, alone again in an empty house.  I can see it all because I've lived it, and now they will too.  I wouldn't wish it on my worst enemy.

***

How is it that so many babies traversing the,what? Maybe 10 cm total?, through the cervix and down the birth canal go from 'fine' in one spot, to 'dead, or dying' and the end?  It seems completely ludicrous that the only 10 cm you absolutely HAVE to cross in your life is the most dangerous of all.  Good job mother nature.  You can be such a cruel bitch.

***

Oh look at that, it's 7 o'clock.  Quitting time.  Yep, just another day at the office.  

Should have been a librarian.