The Greater Measure

There comes a time in every doctor's career when we are forced to ask ourselves some very probing questions. What are we really accomplishing for our patients and for society? What problems are we solving? And what problems are we creating?

I have always been concerned about the number of iatrogenic disorders that exist and seem to increase every year. Every time we merely save someone with a severe degenerative, debilitating disease, whom do we help? Shouldn't quality of life be our solitary goal? The answers to these questions would come soon, delivered in a most unique way.

I got a call from a rural hospital about a baby with failure to thrive. At eight months of age, she could not sit up, roll over, or support her head. Most babies between the age of two and six months typically master these developmental milestones. In addition to the developmental delay, the baby's mother had also noted her daughter was now vomiting at every feeding. A thorough examination and history revealed a devastating secret.

Angelica had an inborn error of metabolism – a universally fatal disease, even with the best of care. Before she would exhaust her short life, she would be completely blind, brain damaged, with frequent seizures, requiring massive care and nurturing. Her young mother, faced with the prospect of what was ahead, decided to desert her in the hospital.

The prospect of the baby being alone evoked a sense of sadness in the entire staff. Every effort was made by the social service staff of the hospital to find her an adoptive mother. And sooner than anyone could have hoped, Karen appeared.

Hope should have been her name. She walked into the role of mother as if both she and Angelica knew that they would be together, as if they had known each other before.

Tube feedings of specially mixed formula would be needed every three hours. This, along with frequent hospital and doctor visits, did not distress the new mom. I could not understand how anyone could manage this level of stress. There was never any indication to me that Angelica ever acknowledged the love that Karen put into every measure of the day, but the sacrifice of love by Karen to this very needy baby was not affected.

The baby's mottled skin and labored breathing would get progressively worse. There was no longer any reason for frequent hospital or clinic visits. Angelica never learned to sit alone or independently support her head. After two months, upon leaving my rotation in pediatric endocrinology, I lost contact with both mother and child. It had been a difficult but enlightening two months. I learned how people can hope against hope, how love really is blind, and how no matter how debilitated the patient, kindness and caring is never wasted on anyone.

Six months later, I happened to meet Karen in the hospital hallway. She told me that Angelica had died, as expected, just a few weeks ago. The now childless mother informed me how much she missed her daughter. So, she decided not to waste another moment on grief. She enrolled in nursing school with the eventual hope of becoming a nurse practitioner. There's that word again, hope. It is ever fruitful, ever timeless.

And so what really happened here? A small, precious handicapped child had, in only a few months, affected the lives of many of the people who had the privilege of meeting her. She changed our lives for the better. She effected societal outcomes for good. And she never made a speech; never wrote a book; never spoke a word. I will never again underestimate the power of love expressed in unconditional kindness. Don't get me wrong, the debate of quality of life and outcomes versus events will be around in medicine for a long time to come. But I am now at peace with the dilemma.

Discuss This Article

Have something you'd like to say? Tell us what you think! Read and post comments for this article.

Find a Job

Choose your career:

MedHunters is the world's biggest healthcare job board. Our job directory has 16,585 jobs with 2,365 hospitals and other direct employers.

We want you to find your next job on MedHunters. Need Help? Call us at 1-888-884-8242, email us at info@medhunters.com or sign up now.