We often find inspiration in our ability as humans to create anew. I too fall prey to the promises of New Year resolutions and birthday candles, beckoning to us with the allure that our future rests in our hands. However, medicine contradicts these notions of self-determination and autonomy. Instead, it teaches us that our pasts have a paramount role in determining our futures.
It starts from the very moment we enter this world. For example, simply the method of delivery can determine our personal biology. Whether vaginal delivery or cesarean section, how we are born determines much of the makeup of our gut microbiome. In fact, research has shown that babies born via cesarean section are missing key commensal bacteria that leave them susceptible to colonization by healthcare pathogens.
We see similarly astounding differences even with methods of nutrition. Immense research has been done to understand the benefits of breastfeeding versus formula feeding, with breastfeeding conferring passive immunity via transmission of antibodies, decreasing risk of obesity and even reducing the incidence of some childhood cancers. One cannot forget the “Baby-Friendly” signs plastered along the labor and delivery wards, reminding all about the importance of the golden hour and the opportunity for an infant to receive skin-to-skin contact with their mother. It is astounding that the first few moments of an individual’s life have the potential to provide such staggering differences that may be felt for decades to come.
After a busy morning in the neonatal ICU, I slipped away from learning about common neonatal infections to hold one of the babies we had skipped over on rounds. As he gazed up at me with one hazel eye — the other already in dreamland — I rocked him back and forth and sent him to sleep with whispers about all that he might achieve one day. Perhaps he would become President, CEO of a Fortune 500 company, or a nurse that takes care of kids just like him.
My favorite nurse practitioner quietly came up behind me and expressed her sadness regarding his diagnosis, neonatal abstinence syndrome. She commented about how disorganized his feeding was, with his inability to coordinate an adequate sucking reflux. She also pointed out how his cry was different than the other babies. It was desperate, yearning for and withdrawing from all his body had ever known.
I was devastated — devastated that statistically, he has a significantly greater chance of experiencing adverse neurodevelopmental, cognitive and behavioral outcomes as compared to his counterparts. Devastated that his risk of future substance use is so much higher due to his biological makeup. Of course, he also holds the potential to emerge against all odds, but it pains me to think about all of the hurdles he will have to overcome.
The bilirubin levels of our weeks-old baby had suddenly shot up, and so had his frequency of apneic episodes. Despite the fact that it was an already busy Saturday morning at the NICU, his intubation became our first priority. While I stood on the outskirts of the crib, slightly shaken by the sight of the oxygen mask seemingly swallowing his tiny face, I wondered who would explain these intense first weeks of life to him. He had been left alone in the NICU, with not so much as a name for a parting gift.
Thankfully, the procedure was completed successfully and he was extubated a few days later. All of us medical students often flocked to his station to give him some extra care and make sure that his red blanket covered his crib, just the way he liked it. Still, I wondered about all that life would have in store for him, and if he would ever be armed with the knowledge that his first few weeks of life were some of the toughest cards someone could be dealt. Would he ever understand why his trips to the ophthalmologist were so frequent, or why his pediatrician cheered loudly when he met his developmental milestones?
My time in the NICU was filled with all sorts of neonates with difficult beginnings — one with two bouts of necrotizing enterocolitis, another with macroglossia secondary to Beckwith-Wiedemann Syndrome. However, the stories of these two babies resonate most deeply with me.
Every encounter with them — through rounds, social work encounters, afternoons spent by their bedsides — reminded me that so many of us live amidst and despite the most difficult circumstances. Some are even greeted into these situations prior to existence, with no control over what is to follow. It is our duty as future physicians to empower these patients, and teach them all of what they have overcome, so as to illuminate their strength and manifest their potential.
Image credit: Pre-Birthday Celebration (CC BY-ND 2.0) by Sue90ca