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Sparrow's Point

They're Accustomed to Our Faces

By Melissa Sparrow

Melissa SparrowWe call it the changing of the guard: the one weekend every month when the doctors on a service move to new assignments in different hospital units. For patients and families who have grown accustomed to the faces and names and medical philosophies of their physicians, the starting over with a whole new crowd can be bewildering.

I learned that lesson from Brittany Brown’s young parents. Brittany was one of the first patients I was assigned during my tenure in the Neonatal Intensive Care Unit, and one of the most ill. I broke into tears the first time I laid eyes on her, a baby so small her body was covered in gel rather than skin. She’d been born very prematurely, but unlike some preemies, she still maintained full potential. Her brain was undamaged. And because of that potential, for us her doctors, the responsibility was deep.

In those first few days with Brittany, diagnoses like bronchopulmonary dysplasia, fungemia, disseminating intravascular coagulopathy and surgical necrotizing entercolitis were transformed for me from words, charts and photographs on a page to the plague of a single body.

Little by little as we cared for Brittany, she seemed to grow healthier. In the midst of X-ray rounds one morning, we even burst into a celebratory spree because Brittany’s lungs finally looked so good—open, expansive and relatively whole. After all she’d been through—the nights that clumps of her lung had collapsed and she’d required chest tubes—the pictures on the X-ray light-rack were dark and deep with air.

Then, in the midst of our delight, everything changed. As the pediatric radiologist continued, she told us that Brittany had a cyst in the germinal matrix of her brain. She pointed to the tiny area of shadow and fuzz on the computer screen and explained that this baby had developed periventricular leukomalacia, one of the greatest risks of prematurity. The brain pathology in this disease carries with it a prognosis ranging from minimal developmental delay to severe mental handicap. The radiologist’s news was not just sobering, it was devastating. It told us that we had failed, that with all our work, our knowledge and our hope, we could not protect our patient from the violence of early birth and the stresses of extra-uterine life.

"We’ll have to plan a family meeting and tell the parents in the appropriate context," the attending said with his eyes to the floor. The rest of us were silent.

That Friday ushered in my "golden" weekend, the one weekend a month we interns have two consecutive days off. And that weekend also signaled the changing of the guard. The Browns’ attending physician left for a new service. So did the fellow. On Monday, our new team rounded for the first time.

"The parents must be told about the ultrasound findings," I reiterated at the end of my morning presentation. Everyone nodded in agreement, and we moved on.

That evening, after seeing the Browns, I continued to write my order, my eyes avoiding them. Did Brittany’s parents know? Had the new attending talked to them? Had the fellow? Should I lead the effort? Time slowed down as the nurse walked toward me. The air thickened. "The Browns want to know if Brittany had that follow-up ultrasound," the nurse said.

What I remember next is the shock and shame I felt at realizing that I knew what that ultrasound had shown when the Browns did not. Stark and clear in my memory I saw the picture that had been produced by a machine that Mr. and Mrs. Brown didn’t even know had photographed their daughter’s brain. But I had seen that picture five days ago. Now the attending wasn’t here, and the fellow was new. Only I was standing there. Brittany was my patient. I was her intern, in my mind a failure twice over.

I searched out the fellow and asked him to explain the ultrasound findings to the family. Luckily, they knew him. He had been the fellow on duty weeks before when the Browns first arrived at the Hospital. I watched him approach them in the corner of the room and begin to talk. I saw Brittany’s mother begin to cry. I witnessed her father turn rigid with fury. Under it all, I saw the ocean of their need: for our compassion, for the survival of their only living child.

The fellow left them to return to a baby whose lungs were filling up. I walked to the family there in the other corner, and summoned courage to speak and listen and stand by their side. We talked long into the night. I was the one face, the one doctor, the one name, who had remained constant throughout their whole ordeal. I was their bridge, a few planks missing, but ready to bear weight.