In my professional life, I am equally dedicated to saving the babies in my care who have a chance at survival and doing so with the highest level of skill and integrity that I can, as I am dedicated to not inflicting unnecessary suffering when it is clear that there is no possibility of survival. These dual goals of mine are not at all at odds with each other, but they do require extreme clarity and certainty of your knowledge. You must have the facts and when they are unclear fight for life. When the information is there you must be able to tell the family so they can understand and work towards acceptance. If you are not objective, this is not possible. There is a certain separation that must be maintained as the attending physician from your patients so that you can see clearly. This is why as physicians we do not care for family members, or those who are like family. Because try as you might, you cannot be objective. However, this is not in anyway to say that you should be withdrawn. As a neonatal intensivist, my humanity, my care, my concern is my center, my driving force. I must care, so that I can do my job to the best of my ability. As I have said the day that I do not shed a tear when a baby dies will be the day I quit. No questions asked, no second thoughts.
These thoughts have been in my head a lot lately. There are many reasons. Starting with my grandfather's stroke and continuing to what was not a very happy couple of weeks on service. Also, I have been trying to counsel some of my junior colleagues on these issues lately. It is not easy because everyone takes it so personally. I am far from perfect, but I do the best I can. I hope that I can still lead by example, and I hope that I can help my junior colleagues find their center in a place that will allow them to balance their lives and their patients lives.