Friday, December 9, 2016

A Pro-Life Neonatologist's Advice to Parents Facing the NICU, by Dr. Robin Pierucci, M.D.

I am a mom and pro-life neonatologist -- a doctor who takes care of premature and critically ill babies in the NICU -- Neonatal Intensive Care Unit.  This specialty is not something I had ever heard of as a child, nor was I aware that being “pro-life” or specifically anti-abortion was even reasonable.  I grew up in an incredibly loving but very “pro-choice” Jewish household.  Plus, I am a product of American secular medical training, with a Masters degree in medical ethics. 

Nevertheless, truly demonstrating God’s immense sense of humor is my reality: a convert to Catholicism, I am a doctor whose entire career revolves around caring for infants who are actually legal to kill.  Ditto for those with a prenatal diagnosis of “lethal anomaly” or “abnormality not compatible with life”.   
While I don’t always do my job perfectly, as a physician I have sworn “to do no harm” to any human being.  So my goal every day is to medically, ethically, and humanely tend to every single person for whom I have the privilege to provide.  And because every baby I have ever seen arrives in the unit with worried adults (often but not always the parents), it is not possible to care for the new arrival without also caring for the parents.

So with this eclectic background, I offer myself to further serve these infants and their parents with a bit of guidance, hoping I might be able to supply you with the right questions to be asking the physicians with whom you are dealing.

To start, a good physician should be able to tell you about each medical intervention with some essential facts as you ask these questions:

1.   Why is this intervention being proposed?
2.   What is the expected response (what will your baby, or the monitors, or the lab tests look like if responding, and how long will a response take?)
3.   What does it look like if the baby is not responding (baby, monitors, lab tests, etc), and over what period of time?
4.   The decision tree: if this happens, what occurs happens next? This is a reasonable question if there is either a good or bad response.  It is also ok for the doctor(s) to not know a complete answer to this question because there may be way too many variables to account for.  However: a. he/she needs to admit what they don’t know and b. it is a reasonable plan to have the same conversation again after you see how the first intervention(s) went.  Be aware, that there will often need to be multiple simultaneous interventions, which makes the answers all the more complicated.  But if you have this basic framework in mind, it should be easier to get a sense of what parameters people are looking at to know if the medicine/surgery or whatever is being done is actually useful.

But what if they say, “there’s nothing to be done” or even “you need to stop medical treatment”?  As someone who believes in the sanctity and preciousness of every single human life and is simultaneously a critical care physician, there are some reasonable questions to ask here (which in itself is an insane statement when confronted with such a crisis!):

1.   In an ideal world, do your homework first.  Find a doctor who is pro-life or at least  knows you and understands how you make ethical decisions surrounding issues of life.
2.   Reality: doctors (just like all of us) are a product of this culture, which means they will need to be educated on your intact value system.  Some will be able to be educated, others — well, not so much, or at least not as quickly as you would like.  Don’t despair (which isn’t equivalent to avoiding livid anger, gut-wrenching fright, or head-spinning frustration).  Breath.  Breath again and inform all involved of some facts:
a.   Your little one’s first and primary diagnosis is “it’s a girl!" Or "it’s a boy!"  This little boy or girl seems to have some additional diagnoses.
b.   These other diagnoses might potentially result in this infant’s life-span being shorter than we would be prefer.  But in the meantime, we are going to do everything we can to maximize what is possible for this little one.
c.   We want to work with you to avoid prolonging suffering.  However, having a “disability” or other “limitations” does not define suffering!  We intend to love this child.  Doctor, we are hoping you will either help us negotiate the challenges ahead or get us to another physician who will be more interested in doing so.

This adventure known as life isn’t easy.  But around every corner are the unexpected joys, unlooked for celebrations, and unsung moments of penetrating peace which are our gift from choosing to live (with the aid of His Grace) nurturing and loving everyone in our lives — especially the most vulnerable.


BIO:  Dr. Robin Pierucci, M.D. is a wife, mother and neonatologist, and now a blogger for Save The 1She received her medical degree from Rush Medical College, and completed both her residency in pediatrics and fellowship in neonatology at Children’s Hospital of WI, Milwaukee.  During the neonatal fellowship, she also completed a Masters in medical ethics at the Medical College of WI.  Since that time she has worked as a neonatologist in Kalamazoo, MI.  Robin has also completed the National Catholic Bioethics Center (NCBC) certificate program in medical ethics and participates on the ethics committee for the National Catholic Partnership on Disability (NCPD).

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