Medical students learn anatomy, physiology, pharmacology, physical diagnosis and the basics of Medicine, Surgery, Pediatrics, Psychiatry and Obstetrics/Gynecology. Compassion, common sense and true caring and concern for your patient and families is not taught in a textbook. You can study and work hard to become competent. To approach your young career with the attitude that medicine is a privilege, not a job, and have humility (humus = ground) or to have firm footing on the ground with no ego, will open many doors for you.

I have learned that the majority of physicians who are arrogant, argumentative and egotistical are uncomfortable in his/her own skin. I have been so fortunate to work with and collaborate with the most brilliant, accomplished, world renowned physicians/scientists. They are the most sincere, kindest human beings I have met. They are gifted by the grace of God and do not put on a false air.

The ego in medicine mixed with the stress physically and mentally can lead to disastrous consequences. Divorce, extramarital affairs, drug and alcohol addiction can devastate oneıs career and family. They sacrificed over 25 years of schooling to Ease God Out (EGO).

Finally, malpractice will be one of, if not the most, significant problem facing the new era of physicians. Condescending, attitude, arrogance and lack of compassion are shown in numerous studies to make one extremely vulnerable to numerous lawsuits. We all make mistakes, but they are magnified with a negative attitude.

There is no right or wrong way in dealing with death and dying. Perhaps numerous losses in my life and the strength of my faith, along with 25 years experience, has blessed me with this ability to deal with the loss of a human life.

She came early, too early! Sixteen weeks early, weighing 1.5 pounds (700 grams) at 24 0/7 weeks gestation, the challenge was daunting. We were fortunate to meet with the family prenatally to explain the national and local data and formulate a plan. I knew deep down this was their first experience having no control. Early good communication seems to establish trust. Survival at best was 30-40%. Intact survival was grim. The risk of a major handicap like blindness, cerebral palsy requiring a wheelchair and never going to school or playing soccer was significant. A moderate to minor handicap was almost certain. The team concurred no cesarean section would be performed. If she weighed over 500 grams (1 pound, 1 ounce) and had a heart rate, we would initiate resuscitation and likely attempt to insert a breathing tube. We will not have to make any decisions. Your daughter will tell us what do. We may gently intervene but never interfere. There was nothing you ate, drank or smoked during your pregnancy that caused this. You cannot agonize over this. We reassured Mom and Dad that we often can never find the reason for such an early delivery. Bad things seem to happen to nice people. A Higher Power, many choose to call God, does things for a reason we cannot often comprehend at that time. This cannot be Godıs will because He just couldnıt let a newborn die, could He?

At 72 hours, a large intraventricular hemorrhage evolved with concomitant nonphysiological ventilatory requirements and an ominous, persistent metabolic acidosis. We anticipated with the family a quiescent 48 to 72 hours with the honeymoon abruptly ending around this time. We know the majority of preterm newborns do not survive beyond the first week. As survival progresses, it promotes strong bonds. This makes getting off that treatment train difficult indeed. We all knew she was telling us it was almost time. We would not prolong death. Mom and Dad brought in family and friends for a beautiful baptism. Their daughter, their angel, wanted to spend some time with Mom and Dad. We all agreed technology was futile and in a quiet room, away from the loud Neonatal Intensive Care Unit, they would spend precious time with her. Your daughter is so beautiful without all those tubes. We assured them she was warm and comfortable and would have a little heart rate and be with them for a while. Your daughter is not suffering. Her going to Heaven will be very peaceful. Hold her as long as you want. You may be frightened at first. Please hold, hug and kiss her. We believe you will treasure this time with her. It will help the grieving process.

After three hours, we pronounced her passage to Heaven. She may have been here for only three days, but she was a part of both of you for over 24 weeks. She can never be replaced and will be a part of your life forever. She did not have a meaningful life, but her life had tremendous meaning. The world today seems more and more tumultuous; there must be a better place. Heaven or its equivalent must be a good place because no one ever comes back. You are going to see your beautiful daughter again.

An autopsy might help us and other newborns. Think about it and let us know. We understand whatever decision you make. Write down any questions that come to mind. We will meet in 4 to 6 weeks and discuss all these blurred events and future pregnancies. In the interim, if you need support groups, have outstanding bills or if you need someone to talk with, just call me day or night, at home or work. The road to acceptance can be tortuous.

Despite years of intense training, death, like common sense, is not easily taught. Dealing with the death of our tiny, vulnerable patients and the impact on their families and caregivers alike is universally difficult and unique every time. Dad not only has to grieve for his daughter but his wife also. The dreams for their daughterıs potential are shattered. We often ignore the impact of death on ourselves. We spend an inordinate amount of training to save lives but a paucity of time learning to help our patients die. We cannot reverse death but certainly can help the healing process. It takes time for time to heal. If we are caring, concerned, competent and compassionate in our communications, our patients and families will be forever grateful. These positive traits can only be an asset in dealing with difficult situations and patients in our future. Thank our patients, large and small, for giving us guidance and wisdom through their departure from this life.

Our stay here is too short. We thank her for reminding us of the miracle of the precious gift of a healthy newborn, an event so commonplace, it is frequently taken for granted. How fragile our seemingly tenuous grasp on life is. Life is a delicate thing.

I have experienced too many bad things happening to wonderful people. The concept of death and the suffering family drains me emotionally, physically and spiritually. I thought experience was the best teacher and this would get easier with time. It doesnıt and I am glad. Treating the human spirit reenergizes me. I need to share this humbling experience with a medical student or resident that we, as physicians, are blessed to witness.