Withstanding the vicissitudes of emotions in the midst of life-limiting decision making in neonatology is depicted in a poem. Positively embracing inaction when one is trained otherwise in this critical care subspecialty could even be regarded by some as counterintuitive. At 34 weeks of gestation with rapidly increasing head circumference and antenatal MRI confirming inoperable severe hydrocephalus with 3mm mantle of cerebral cortex, a collective decision was reached along with parents to deliver the infant and not to offer interventions. Ensuring the pre-agreed palliative and end-of-life care-plan, while supporting the emotional burden of parents and staff is often challenging.
Tears in her left eye said, thank you
Spilling over to the cheek, said thanks again.
Tears in her right eye said, sorry
Not to me, to her son for whom I did nothing.
He cried swiftly at birth, I opted not to hear
He sneezed twice or thrice, I chose not to assist
He cried again a bit louder, as if I didn't hear it first
He looked at me once; I gazed away like a coward.
Withdrawing is tough, withholding is tougher
Justifying my actions, in the midst of muddled thoughts
May be this is tough love, if so in its purest way.
May be this is destiny, if so I'm just a catalyst.
I gently closed his eyes, my only good deed of the day
His thin mantle of brain whispered, thank you.
Now I'm confused, has he a mind?
Was it the life, mind or soul that left him today?
Perhaps I played a part, just a plea for my passivity
Escorted another life away, to a world unknown to me
Pardon me, pardon me, I said in silence
I'm sure he heard it well, though no one else could.
Acknowledgments
Parents of the infant as well as the staff of labor ward, operation theatre, neonatal unit, and postnatal ward of University Maternity Hospital Limerick (UMHL), Ireland.