Extraordinary knowing: Remen excerpt #13

Dr. Remen writes: In response to an invitation to remember a moment in the practice of medicine that might be considered a sacred experience, a seasoned neonatologist, the director of the neonatal unit at a large southern hospital, offered a group of colleagues this account. After weeks of struggle, her patient, a tine premature baby, was dying despite everything that a state-of-the art intensive care nursery could offer. It would not be long and it was time for the parents to say good-bye. With a heavy hear she called the baby’s father and invited him to meet her at the hospital. The child’s mother, distraught after weeks of uncertainty, now required medication. She had stopped visiting a few weeks ago. He would come alone, he said.

As she put down the phone, she became aware of the beeping of the monitors and other machines and the bustle of the  intensive care nursery and felt the need for some quiet to organize her thoughts while she waited for him to arrive. She went down the hall to the chapel, the only quiet place nearby, to be along for a few minutes and find words to tell the young father that his little son was not going to make it.

Fifteen minutes later, as she was walking toward the visitors’ waiting room, she found herself thinking that perhaps she should give the baby a trial with a certain drug. The thought surprised her, as this drug was not customarily used for the baby’s problem, and she shook her head in annoyance. But the strange thought would. Not easily go away. She reviewed the baby’s course with the father, assuring him that everything possible had been done and suggesting they go to the intensive care nursery together to say good-bye. As she looked at the sadness in his face, she found herself thinking ;After all, what does it matter?’ and suggested that perhaps there was one more thing she could try, a drug not usually given for this condition, but which she was thinking of using now. She would like to have his permission to use it. He gave this readily and they went to the nursery together.

The baby appeared moribund. Embarrassed to make so unusual a request of the nurses, she prepared the injection and administered it herself. Together she and the father waited, standing on either side of the Isolette, watching the blue and gasping baby. There was no change. Wanting to give him a chance to be alone with his child for the last time, she left to do some paperwork. A few hours later, she looked into the unit and was surprised to see him still there. She approached the Isolette and found that the infant’s tiny chest had slowed and his breathing was normal. Scarcely able to believe her yes, she raised her head and found the father looking at her. Their eyes held for a long, wordless moment. This was the moment she had chosen to tell us about as a ‘sacred’ moment. Recently these parents brought their child back to visit her. He is twelve years old.

The circle of physicians sat thinking about this for a while. Then the neonatologist began to describe the way in which she had dealt with this strange happening at the time. She has a very orderly and pragmatic mind, she told us, and it had disturbed her. She had tried to find an explanation for it so she could dismiss it. Gradually she became convinced that somewhere she had read or hear a preliminary report of research which mentioned the use of this drug for the baby’s condition and this was why she had thought of it. She could not remember the journal or the meeting where she had gotten this information, but she became more and more certain that it was so. This allowed her to forget the whole thing.

About two years later, she read of a study of premature infants with severe respiratory distress who had been given this very drug and had recovered. The mystery was solved! Delighted, she called the researchers to ask where they had published their preliminary reports or presented their work in progress. She was stunned to discover that this article was the first time the study  had been written up or presented anywhere. It had just been too odd to talk about until the results were final. She told them then that she had an additional case.

 

In musing aloud about her personal reactions, she told us that she had clung to an explanation that would have allowed her to keep her familiar and comfortable sense of the way in which the world works. She had rejected the gift of awe once, so it had been given to her again.

 

Rachel Naomi Remen, M.D., Kitchen Table Wisdom: Stories That Heal (Riverhead books, 1996), page 318.