I love newborns. They are so perfect, as untouched as anyone can be by outside influences. They love unconditionally; all they need is milk, a clean diaper, attention, and snuggles, and they are happy to see you (metaphorically – they can of course see very little at this age). So working in the newborn nursery this month was an absolute delight. A new baby is nothing short of a miracle; I am reminded of this every day.
In addition to the fact that an infant has to figure out how to live outside the uterus (their oxygen and nutrients no longer come through their umbilical cord! What an adventure), new parents also need to learn basic skills to care for a newborn, things that are nonintuitive to those who have not done it before. We regularly assist first-time mothers with breastfeeding. The other day I taught one new father how to change his first diaper and another one how to swaddle his baby. Even bottle-feeding, burping, and holding a child are things we historically learned from the multi-generational support systems we resided with (ever-limited during the pandemic) as we welcomed our progeny.
It is incredibly gratifying to provide such basic, but life-changing education. It is also great to know that we are doing our best to give these newborns the best start. We follow their transition into the world and track their bodily functions, but also give them medications to prevent devastating diseases. The three most important treatments we give to infants are:
- Topical erythromycin to prevent ophthalmia neonatorum (conjunctivitis that can lead to blindness)
- Intramuscular vitamin K to prevent spontaneous bleeding due to vitamin K deficiency
- An intramuscular hepatitis B vaccine to start them on an immunization schedule that will hopefully provide lifelong protection from a slew of infectious diseases to them and others via herd immunity
Most families accept all of our interventions without questioning them; they assume that as the pediatricians we have their baby’s best interests in mind and will do what is indicated based on the available data. Every once in a while, however, we encounter parents who refuse one or more of these medications. As a physician who wants to do what I think is best for the child, this can be frustrating for me, especially since my patient is not making the decision for themselves. But it is ultimately the parents’ choice.
The most difficult circumstance is when the parents refuse administration of intramuscular vitamin K. Because of the increased risk of vitamin K deficiency bleeding that is almost eliminated with its administration, parents need to sign a form indicating that they were educated on the intervention and made an informed choice to refuse it. I detail the risks, especially of spontaneous bleeding, and try to convince the parents to change their mind.
In my brief time as a pediatrician, my success rate is 0%.
It is exasperating. But I have to remember in these cases that the infant’s parents and I have the same goal: we want the baby to be as healthy as possible now and in the future. I know why I believe that they need the injection, and I have a hard time accepting why they believe it is unnecessary or possibly harmful. This frustration is normal. But even if my patient’s parents don’t make the same decisions as me, I need to understand where they are coming from. Only then will I be able to provide the best care possible for their child in every other aspect of their health.
This is why perspective is important. Understanding their story can help us to realize the basis for their decisions.
It is not only important in patient care, but in all of our interactions in the current climate during the pandemic. We all want to minimize death and suffering without completely decimating the economy. But we don’t know the best way to do that, and we all have different perspectives on it. It is something we need to be open to exploring.
The prompt for this week is this:
“Write about perspective.”
You have as much or as little time as you would like to take. See you next week.
More unedited writing of mine. All about perspective.
Shaped by the Current
Oh to see through your lens,
That which you use to gaze at the world,
The glass shaped by the current
Of your life,
Like a stone smoothed by
Years in the river.
The canyon in which you reside
Blinds whole swaths of the sky.
Carved by that powerful stream,
Year after year
Slowly etching the same path
Into permanence.
If only I could climb
Out of my own immovable canyon
And into yours.
Would I see then
Through your lens?
Be privy to your view of the sky?
The beauty of the landscape
Lies in the variety.
The cracks in the rock,
The misshapen stones.
But for my piece of the sky
You cannot see.
And yours hidden from me.
Keeping us from empathy.
Writing for Wellness 