I was going through some old files, and thought you might find this post meaningful.  I wrote it years ago (in fact, before my eight-year-old daughter was born), but it remains relevant.  We are so vulnerable when we love…and medicine reminds us of that every day.

VULNERABILITY

 

One early morning this summer there was a tragedy.  It was not large enough for national news.  It did not concern the masses of people, who would still move quietly through their normal lives like canoes slipping through quiet water.  But it was still a tragedy, and sometimes small tragedies make sharper images, more readily comprehended by observers. Unfortunately, they are also more easily applied to other lives by analogy.  I was an observer of this event, or part of it.  And although intervening in tragedy is part of my job description as a physician, this one was harder to face than most.

That morning, a young couple woke in the darkness to find that their infant son was not breathing.  They called 911, and an ambulance was dispatched to their home.  However, they did not wait, and drove to the hospital with an urgency born of love, fear, hope and despair.

Knowing they would arrive quickly, we made preparations, opened equipment boxes, put on gloves and waited.  Through the ambulance bay doors we saw a solitary car speeding towards us with lights flashing.  We ran to them as a frantic, sobbing mother handed the infant, five months old, to one of our nurses.  We began to work as soon he was placed on the hospital bed.  A dazed father parked the car.

The infant was stiff, with the blue cast of a death that had occurred perhaps hours before.  I suspected Sudden Infant Death Syndrome, or SIDS. Still, we worked for a long time, because it never seems like long enough when a child is involved.   Every parent in the room saw their own child lying there, and even as we tried to be realistic, the idea of stopping, the idea of surrendering to mortality was just too much.  In the end we knew what we had to do.  One of the results of years of practice, as a nurse or physician, is the ability to know death when you see it. We looked at the clock, looked at one another, and stopped.

There’s always a painful silence when a resuscitation ends.  Medical television shows can’t reproduce it. The quiet rhythm of chest compressions, reflected in beeps on the heart monitor, ceases. The sound of artificial breathing is gone.  The tearing open of medications, the flow of orders and confirmations, the nervousness in the voices of the staff, all suddenly quiet.  The monitor silently draws a flat, green, electric line, then prints a strip of paper with a flat line for the record.  It is switched off without ceremony, without any requiem to mark the end.

Whether the deceased was child or adult, I usually stand a slight distance away from their body and look at them from head to toe.  I try to take them in, to log them in my memory.  Not out of morbid fascination, but to somehow preserve a bit of them, or imagine them alive, or to honor their humanity in the solitude of my mind, like some brief memorial service.  Looking at this child, I saw that he was beautiful.  He was fair, and came to us dressed only in a diaper. He was perfect in form.  As a father of three young sons, I remembered this age.  Five months is an age of rolling, laughing and recognition.  It is an age of bonding, rocking and early play.  It is an age in which you still marvel at the indescribable softness of infant skin, the sweet smell of warm infant breath as a child lies on your chest asleep.   I saw my children before me, and prayed quietly that they were safe at home, even as I had prayed that this child would live and that his parents’ hearts would survive, as he had not.

I managed to suppress the internal analogies to my own sons.  I accepted the inevitable internal review.  The “what else could I have done” that always comes. I trained for all of this.  Still, the worst part was the last. The walk down the hall to parents who sat waiting for news.  As I stepped into the conference room with one of the nurses, I saw the mother, tear streaked, rocking silently back and forth in her chair.  The father, still stunned, on the phone with family.  I sat down and explained what had happened.  They expected it, I think.  They wept openly, but I think they knew when they picked him up, cold in a warm bed, that he was gone from them.  My heart broke too.

Then a stunning thing happened.  I had called the child by the wrong name, which had somehow been given to the clerk at the desk.  The father corrected me.  “You mean Elijah.”  Elijah.  It means, “The Lord is my God,” in Hebrew.  Elijah is also the name of my 15 month old son.

I was shaken.  I told them how sorry I was.  In seven years of practice I haven’t yet learned to cry with families, but I was close that day.  I needed desperately to leave the room.  I finished the shift as the stream of other family members came and went to the room where their Elijah lay.

Finally, I went home to my wife and boys.  As I walked in the door they mobbed me as only little boys can.  Elijah was laughing and running with his older brothers, still in pajamas from the night.  I picked him up and held him close to me.  He gave me an obligatory snuggle, squirmed away and was off for more wrestling and squealing.   But while I held him I marveled and rejoiced in his life.  And mourned for the other Elijah and his parents.

Fatherhood is unbelievable.  It is a daily exercise in joy.  It is loving, nurturing, teaching, playing, laughing, crying, punishing and rewarding.   It is so many things.  And as modern fathers we have learned things our fathers, and theirs, never knew about the joy of involvement in our children’s lives.  But one of the things we seldom hear about is the curse of fatherhood, which is vulnerability.

I sometimes think that our ancestors, recent and distant, were smarter than we think.  We too often condemn them retroactively for their absence in child rearing.  But perhaps it was a habit developed long ago, by men who knew too well the pain of loss, when children’s deaths were all too common.  They knew that their wives would be crushed by loss, but maybe felt that distance would protect them from pain in a time when men’s emotions were things they understood little, and articulated even less.  And when stoic strength was the way men coped with their pain.

I suspect that they knew well that once we have loved fully, once we have surrendered entirely to a consuming passion for our children, we are somehow hostages. Whatever happens to them will affect us forever, and in tragedy bring us closer to destruction than anything ever could have before.  I don’t like this part of fatherhood, which looms over me every day of my life.

I was so affected by my vulnerability that day that I could not tell my wife the whole story.  I skirted the issue, mentioned a SIDS death in our morning debrief over breakfast, and went on.  I wanted to tell her what I had felt.  But in my personal neurosis, feared that to mention it would somehow call down danger on my child.  This is one of the irrational thoughts stored in the cabinet of fear that I keep as a parent.  I try to keep it shut, but sometimes events unlock it, and the door swings wide as horrible daydreams and nightmares combine to fill me with paralyzing anxiety about my children’s lives.

Fatherhood is an expensive venture.  It costs us far more than money.  It costs us our time, our youth, our energy and our freedom.  But the most burdensome part, for me, is the price of vulnerability.  And as I looked into the eyes of that child’s father and mother, I saw that they had paid the ultimate price of love, far higher than I, as abstract vulnerability became horrible reality. I prayed all that day for them.  And I prayed that I would never fully understand their pain.