unconditional

I have just come off call. Though my body yearns for my bed, my mind is still wide awake.

I had just gone through a difficult situation. A week old baby born at 24 weeks who from birth hit one rough spot to the next. As I came on call, I knew this rough spot will be erased but the baby along with it.

Scenario: gram negative sepsis in hypoxic respiratory failure, in DIC, pressor resistant hypotension (already on dopamine, dobutamine, epi drip and hydrocortisone) and in renal failure to boot. The parents were staunchly religious and believed in miracles. I again came face to face with the shadows that haunt me. I do not want to be that person who extinguishes the flame of hope but the task has befallen onto me.

I do the talk.

He is dying. If he survives, it will be no miracle. Given the fact that he is extremely preterm and the tenacity of this infection and its sequela, he is almost 100% likely to be severely neurodevelopmentally impaired. Will it be a miracle when there would be no living?

Options: continue, withdraw, DNR

Mom breaks down. Father silently wipes his tears. What do we do?

What should I say? Medically, I recommend withdrawal. All indicators are pointing towards a hopeless cause despite the best efforts.

What did I say? I believe you have to look into your heart and trust your instincts. As parents, you will only always want what is best for your child. Not for you. For your child. Whatever decision you make, I know it is because you love your child.

I feel spent.

The baby passed quietly this early morning.

They let go.