Next to a 300g premature baby… What does ‘pain’ mean to the doctor cutting the umbilical cord and inserting the tube?

Some births come with deaths. No matter how many times I repeated the experience of becoming a doctor who had no choice but to look at a baby born with the fate of death and not be able to save it, I could not get used to it.

I remember having to pronounce my first death in a trembling voice on a 14-month-old child as a resident, and sobbing breathlessly as a premature baby the size of her palm lay dying in the hospital room where her family had left.

Stella Hwang, a professor in the neonatal department of the Department of Pediatrics at the University of California, USA, realized something at some point. “At one point, I felt like parts of me were falling apart. So I started writing.”

■ The reason why a neonatal intensive care unit doctor started writing

Professor Stella Hwang, who serializes the story of ‘neonatal intensive care units’ in <Hankyoreh 21>, visited Korea ahead of the publication of <Love is not proportional to time> (published by Still Spring). On October 16, 2023, I met him at the Hankyoreh newspaper office in Mapo-gu, Seoul. Contrary to his image, his voice was bright and cheerful.

–Please explain how neonatal intensive care doctors work differently from general pediatricians.

“Babies born extremely prematurely weigh 300g or 500g. Then the prayer is really too small. It is difficult for general pediatricians to open that small mouth, insert a laryngoscope, and intubate. They cut the umbilical cord and insert a tube, compress the small heart, and insert a needle or tube into the chest to remove air or water. The unfortunate thing is that I can’t do it all on my own. “Because it is a situation where life and death depend on every minute, we need specialized medical staff, including doctors and nurses, to save the child.”

-For the doctor, he is one of countless patients, but for the family, he is the only doctor, so it seems more nerve-wracking.

“When there are really many patients, there are times when there are 80 patients in charge in one night. That’s a lot of talk. But I’ve heard this before somewhere. A fellow doctor went to the emergency room because his child suddenly had convulsions. He remembers every moment, every moment, and the facial expressions of the doctors he met on the way to the pediatric intensive care unit. When a child becomes sick, it is a moment that this family will remember for the rest of their lives. “I empathize with the pain and try to be careful with what I say.”

–Although it is the neonatal intensive care unit, there are also happy memories, aren’t there?

“At 22 weeks, there was a baby born in the worst conditions. Complications are complications, and I experienced all the complications of the neonatal department. Everyone said, ‘That child can’t walk’ or ‘It will be difficult for him to live a meaningful life because his development is so delayed.’ But the child was so lucky that she overcame all the complications and was discharged from the hospital. She slept well and came running towards me from afar, wearing her glasses. “She cried on the spot.” 

■ A doctor is not only for the patient but also for the ‘patient’s family’

– In the series, there is a story about parents who had a happy time after giving birth to a child with trisomy syndrome who could not live for less than a year. (No. 1472 ‘Elliot left at 99 days old, (See ‘Parents floated 99 balloons at funeral’) The survival rate of babies with heart disease is similar to that of premature babies at 24 weeks, and no one asks mothers who give birth to premature babies whether they will send the babies to them, but the death of babies with heart disease is taken for granted. It was also impressive. Is the United States a better environment to live in and raise a baby born with a disease or disability?

“I lived in Korea until I was 20, so I actually didn’t know much about the situation in Korea, but when I became interested, I started looking into it. In the United States, it is often thought that medical expenses are expensive, but if your income is below a certain level, you are required to get insurance and do not pay at all. Additionally, it is natural in American schools to have a culture of supporting special education for children with disabilities. The United States is not perfect, but it seems like there are many parents in Korea who spend their own money to receive developmental therapy. “I think there is a tendency to do this more in the United States because it has a strong culture based on diversity.”

–You wrote a lot about pain during the series.

“Pain is a very important topic to me. Doctors are often educated as ‘people who save people’, but I think they should be taught things about death and the patient’s perspective. Sometimes I wonder if a doctor’s job is to care for not only the patient but also the patient’s family. We don’t call them patients, but say things like, ‘Stella, your child is very sick right now,’ but when we look at a child in pain, there are moments that feel like ‘selfishness disguised as altruism.’ It’s difficult when you cause pain for so long to a baby who would have already died if it weren’t for modern medicine. If you drill a hole in the baby’s neck or stomach, they will struggle in pain. We often think that pain becomes dull, but the more pain we receive, the more severe and sensitive it becomes.” 

-Naturally, I think I would worry about euthanasia.

“California has passed a law related to euthanasia, so terminally ill patients can be tested. If the decision is made through normal cognitive processes and not due to depression, then it is possible to take medication and leave the world. Personally, I thought that way when my father passed away when I was in high school. The selfish thought that it would be nice if he could just survive on a ventilator. Even if life is not life. Of course, there are moments when you think, ‘I thought this, but what if that person is actually the happiest person in the world?’ However, in cases where there is no hope for the child to survive and only pain remains, there are times when the family is advised to stop. In fact, it makes no sense to ask parents to choose whether to stop or not. “Medical advancements have forced parents to make very difficult decisions.”

■ I now know that I can ‘choose’ suffering

– Looking at reader comments, there are many reactions such as “It hurts to the point of tears,” and “I can’t bear to say it.” How do you bear it while watching such a painful situation?

“At some point, the events I experienced온라인카지노 were replayed, replayed, and repeated. Looking back, I think it was a trauma. It piled up so much that at one point I thought, ‘I’m going to get really sick if I keep doing this.’ I started writing. “By reading various books to write, I was able to learn a lot and recover my mind.”

–What did you think during the process of reading and writing?

“There is a book called ‘Empathy is Intelligence’ written by Jameel Zaki, a professor of psychology at Stanford University and an authority on empathy research. There is an experience of being in the neonatal intensive care unit after a baby suffered a stroke during birth. There is a line that says, ‘If sadness were light, the place where the neonatal intensive care unit is located could be seen immediately from space.’ That’s where I am. There were times when the mother and father calmly left the baby and went home while the baby was dying, and the medical staff cried while staying by the baby’s side. (Refer to No. 1445, ‘No one should die alone’) In the past, you had to keep thinking and suffering for true empathy

. , I thought it was about sharing true pain. She blamed herself and tormented herself. Now I realize that I can ‘choose’ suffering. Even if you sympathize, I think you should not bother me. Inspired by this book, she also wrote her second book, “I am a doctor who cries before death every time.” It is scheduled to come out in May 2024. “All royalties from the first and second books will be donated to the Green Umbrella Children’s Foundation.”

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