Dignity

I try not to write about death too much, but it is tough to escape the topic when talking about healthcare here.

Some of the most important lessons I learned in residency didn’t come from books.  They came from the caring and professional staff I worked with.  The neonatal nurses and physicians in the NICU (neonatal intensive care unit) were especially instructive in the art of caring for patients and their parents at their most vulnerable moments.  We had a very ill baby come in this week, and despite several days of good treatment on Friday it became clear that he was not going to survive his illness.  I told the grandmother that we’d done all we could, and that her grandson did not have much longer to live.  She took a moment to digest what I’d just told her, then quietly asked if she could take him home.  I agreed, and prepared the baby for his final journey home.

As I disconnected lines and tubes, carefully cleaned him up, dressed him nicely and wrapped him in his soft blankets, I realized where I’d learned this ritual – this last act of kindness for my patient who would not survive.  I learned it in the NICU and the PICU where I trained, the places where our most critical patients sometimes spent their last ways.  It was there that I worked with incredible nurses who treated their patients with the care and dignity that they deserved, whether it was their first day of life or their last.  The practice helps me as much as it helps the patients and the ones who love them.  It is my way of saying “I have not abandoned your child.  I still care, even if I cannot help.”

I’m not sure what the Haitian providers think of the extra time I spend on these children in their final moments; death here isn’t treated with much ceremony.  It’s just too common.  But I think it’s important, when it’s possible, to take the time out to get that part right – to give them those final moments of dignity that they deserve.

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3 Comments

  1. The DAd

     /  February 13, 2012

    Dear darling daughter Dr Sara

    Live isn’t always about what we want it’s about what we get. And in your case you are giving but I think you are also getting quite a lot back In return.

    The military goes to war with the army that it has NOT the army it wishes it had. So in Haiti they will get the love and care that they deserve, not what they have grown accustomed to.

    Keep giving a damm and at a certain point the light bulb will go on in the heads and they will see that caring is the most basic of instincts.

    Love ya

    The DAd

    Reply
  2. Laura

     /  February 13, 2012

    I just wanted to say as one of those NICU nurses it warms my heart to know that someone has noticed the little things we do. Death is never easy and it takes a very caring person to not just ignore it and leave the family to deal with everything. Sometimes the simple things like having a family participate in a bath goes a long way. To me it is all about creating the best memories possible for what must be one of the worst times in a parent’s life. Children, and especially infants, aren’t supposed to die. It just goes against what feels like the natural order. From what I’ve read of your posts I realize that death is much more common there, but to me I can’t see that it makes it that much easier to the parents.

    Keep doing what you are doing. Even if one other person picks up on it and repeats it with another family it is worth it. And to the family you have shown that even if there is nothing left to do you still care about their child.

    Reply
  3. Thanks for the comments. I do hope that my small acts might inspire others, but even if nobody notices I think it’s the right thing to do. Laura, I am absolutely grateful for the time I spent in the NICU with you and the rest. Residents do pay attention sometimes. 🙂 You never know where the valuable learning will happen.

    Reply

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