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Date: 2021-04-17 00:30:03

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 our patients. 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-patient relationship.


Date: 2021-03-30 15:08:33

"There is a need to instill a sense of how important our influence and presence is to our patients when they experience their losses. As physicians, we must formulate an approach which will permit us to provide our patients the comfort and hope they require and should expect from us. I believe we must grasp and understand our own feelings to better serve our patients: we must serve our patients though both science and humanism. By becoming more introspective and more emotionally involved in what we are doing, our compassion will become evident and our patients will benefit. Technology indeed provides better diagnostic and therapeutic medical care, but as more technology is developed and utilized, health professionals may become more reliant on that technology and less on their interpersonal skills. They will have to learn –or relearn- and practice the traditional art of medicine, of listening and talking to patients, holding their hands, being at their bed side, while complementing the use of modern technology and advanced science. We as physicians must assure that the benefits of these technologies are fully realized but that their expanding sphere of influence does not disenfranchise the patient nor de-personalize the physician-patient relationship.


Date: 2021-03-30 15:08:33

"Inherent in what defines the physician-patient partnership is an unfaltering responsibility of the physician and an unconditional trust of the physician by the patient. Together these bond the chasm between the vulnerable patient and the knowledge and experience of the physician; a synergy of the need for care and the privilege of caring. I believe the medical professional at all levels must step back from each moment in his/her patient care routine, and reflect on what he or she is doing, why it is being done and what influence it is having on their patient’s lives. This self-reflection is integral to professionalism for it encourages the formation of a philosophy of care and ethic of practice, which in turns fosters self-examination and meaning, empathy and compassion." M.Berman


Date: 2021-03-30 15:10:07

Affirmations

You are the dedicated and the dear;
Who bravely face the abyss
With courage that speaks
Your truths
To the unfaltering oaths
Upon which you swore;
A grace of caring
Which comes from your
Outstretched hands
and noble souls and more…
Your calling:
A strength,
To strike and penetrate
As coulters1
to shear each morsel
Of disease and despair
Into infinite shards;
To awaken the safely guarded
Hopes of humankind’s promise
As life’s order is at last restored,
Returning to us the dreams
To freely breathe the air,
To walk hand in hand
Upon the byways and the beaches,
And travel distant shores,
And speak of todays and tomorrows
Once again with smiles
And even drops of tears;
Gleams of gratitude and affirmations,
For you, the dedicated and the dear.
© 2020 Michael R. Berman, MD


Date: 2021-03-30 15:10:07

Today as Thanksgiving, 2020 approaches, I would like to recognize the mothers and the children, globally, who are starved for food, and the many who give of themselves to aid in their struggle to survive with the pain of hunger.

One such person and organization among many is Kate Hudson, World Food Programme ambassador, for the UN organization, World Food Programme recipient of the 2020 Nobel Peace Prize. (http://www.wfp.org). I am dedicating the following excerpt from a poem I wrote to her and the UN World Food Programme organization.

Dreaming of Amalthea

..and dream...of those, and thank,
Who reach beyond the bar,
Whose conscience lives both near and far
To hear the cry; hunger's cry,
And stand steadfast, aware
To know their vision be to share
Their harvest with those they've seen
To sleep on city streets
and upon parched earth,
where leaves once lush and green now crack,
and lifeless, barren branches fracture ;
Where famine be the slayer.

Excerpted from the poem, Dreaming of Amalthea, dedicated to those who unselfishly commitment themselves to feed the needy. Amalthea, the horn of the goat that nourished Zeus, is the root origin of the term, "cornucopia or horn" of plenty.