Just today, I have come home after a long 24 hour call (more like 30 hours). A late preterm baby was born with a complex congenital heart defect, hypoplastic lungs, cystic kidneys and other abnormal physical features. To add further insult, it was complicated by meconium aspiration.
Advances in prenatal diagnosis made it possible to detect these problems beforehand. Consultation after consultation done with physicians seemed to have indicated that there is a medical and or surgical answer to this baby's anticipated problems. After all, the chromosomal study done antenatally was 46 XY. I think that is about the only normal thing going for this baby.
So what happened? We intubate, put the baby on high frequency jet ventilation, give surfactant, start nitric oxide. Maximal support.
Why? Because we can.
The result of our efforts? A baby with a strong beating heart.
She is alive. But will she have a life?
I have been here in Canada over a year now. It never ceases to amaze me that we will just about resuscitate any baby with whatever affliction. Medicine has evolved in such a way that there is always some form of treatment available for conditions which may have been deemed incompatible with life a couple of years ago. Being humans, we have long sought to be masters of our own mortality, or perhaps, immortality. But to what extent should we intervene in the natural selective processes of life?
Honestly, while I was standing by the warmer working on the baby, I found myself suddenly stop and think, "Is this what I want to do? How far do I want to participate in this exercise?" On the other hand, should I pass judgement on this being? Who am I to say that she wouldn't be productive and happy in the future should she survive? Should the word miracle be a part of medical syntax?
The resus nurse assisting me gave me a nudge. "Are you okay there?"
I think not.
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