Date: 2020-10-15 15:02:23
Contributor: Michael R Berman MD
The first song on earth
Was a child's cry,
A canticle of absolute beauty.
Each note a bequest for eternity;
Ageless music of heartsounds
And first-breath sighs
The promise of humankind.
Aoide is the Greek Muse of Song.
Date: 2020-10-04 14:21:31
Contributor: Michael R Berman MD
Topic: Some thoughts about caring for the loss of a pregnancy or newborn
When the outcomes of our patient's pregnancies end in miscarriage, stillbirth or infant death, we
struggle to find the right approach to break the news to them, treat them medically and/or surgically,
help them recover physically and emotionally, and console them in their grief. Most of us have not
been taught to provide this bereavement care. We learn fast that there are hospital nurses and
social workers, bereavement counselors and therapists, support groups and religious ministries to
whom we can refer our patients for immediate bereavement care and subsequent follow-up. We
can do the D and C and we can attend and assist in the birth of the baby who has experienced an
intrauterine death. But then, for many Obstetricians, we refer our patients for bereavement care.
When we hold in the palm of our hand an 18 week fetus immediately after our patient miscarried or
attend the stillbirth of a term pregnancy, our intellectual knowledge and rational thought fade as we
struggle to find the right words to say. Unlike the repetition of performing a surgical procedure, no
matter how many times we have experienced a loss with our patients, it does not become easier.
Although the stillborn baby which might have been born viable represents the greatest emotional
and management challenges, we must recognize any loss in pregnancy as a life-altering event for
The care of the patient experiencing a Pregnancy Loss is a paradigm for what we do as physicians.
It tests not only our clinical skills and judgments but stretches the fibers of the human aspect of
caring very thin. Although we might ask, “how can we heal when our patients’ children are
incurable, when they are suffering or when they die or what do we do when the advanced
technology that has become a part of our black bag fails”, we must understand that we can heal by
providing comfort , empathy and hope. As bad as this experience is for our patients, we can make it
better. If we remain aware that we are the link between the stillborn baby and the bereaved family,
that we were the first to touch and hold their child, albeit their stillborn child, then we can share this
with them, remember this with them, and from this point forward, heal with them. The bond we form
becomes the unbreakable fiber, which strengthens and indeed cements our role in the doctor-
There is Art as well as Science to caring for the parents of a child who has died, either before birth
or afterwards. Countless mothers and fathers and those close to them silently grieve with little
resolution over the loss of their pregnancies, newborns and children. Seeking reprieve from their
sorrow, they cry and yearn for solace and hope, many times for years following their loss; cries that
are but a muted weeping of despair as a child so longed for is not born, or is not born alive, or dies
during childhood. Pained by these losses, their lives seem devoid of hope. The joys expected from
normal childbirth and child-rearing turn to sorrow. We as physicians share with them in this tragedy
as now the balance between caring for the well being of the child shifts to caring for the tolling
physical well being of the mother and father, the agony of their emotional well being and that of
their immediate family. The shadow of their grief will be indelibly imprinted in their minds and souls.
Death may strengthen or threaten to tear apart the bonds of their relationships with friends, family
and themselves. We, their physicians must recognize the impact of these losses, be the first
responder in this time of need, and abet the healing process, no matter how long and difficult. The
loss of a child brings to us pain that is primal and endures forever. Poetry enables us to ask why
even when we already understand how. It permits us as as healthcare providers, witness to the
frailties of our humanity, to abet healing through the very core of what makes us human, our
language and our personal emotions.
Poetry is my venue for “self-reflection”. A synergy exists between poetry and medicine for each
share from their origins themes of life and death, sorrow and despair, love and futility, promise and
hope. A simple poem can transfer frosts of despair and gleams of elation inwards when written on
the occasion of a birth or a death, a tribute or a memorial, a secret feeling or a revealing epiphany.
The impact of words and thoughts at these difficult times are universal. Sometime ago, I received a
note from a father who just had lost his prematurely born daughter to the condition called twin-to-
twin transfusion syndrome. One twin died in utero and the remaining twin was born at 25 weeks,
gravely ill and on life support systems in the Newborn Intensive Care Unit. After a brave but futile
struggle, she, too, died. Her father contacted me from England, asking if I could suggest some
words to read at the memorial service for his children. I sent a few lines to him and his bereaved
wife. In their reply I learned that they placed these words upon the headstone of their twins' grave.
“Let us not succumb to this portent,
The solstice of our darkest hour.
For it is but a finite point
Upon an infinite journey
Which began with all creation and
Upon whose path walk
The souls of our children;
Pure as the silence of the virgin winter,
Alive with winds of indomitable hope.