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On Being a Doctor |

Confluence at Life's Extremes

David A. Silverman, MD, PhD
[+] Article and Author Information

Hebrew Home and Hospital, West Hartford, CT 06117. Requests for Reprints: David A. Silverman, MD, PhD, Hebrew Home and Hospital, 1 Abrahms Boulevard, West Hartford, CT 06117.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(7):615. doi:10.7326/0003-4819-120-7-199404010-00014
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I spent last winter in the Neonatal Intensive Care Unit (NICU). This was a radical change from my usual venue, where the average patient is 86 years of age and the typical child past menopause. Although I am a faculty member, because I am a geriatrician my privileges in the NICU were defined by parenthood. Delivery of our first child was precipitated by placental abruptio, after a gestation too brief for Sarah Beth to survive without the expertise of physicians, the risks of high technology, and the mercy of something I don't quite believe in. One cannot grow from fertilized egg to free-living baby girl in just 28 weeks without singular help, substantial resources, and a bit of luck. She was 2 pounds, 4 ounces at birth and at her smallest weighed 1 pound, 13 ounces. We were warned that she would probably need mechanical ventilation and, barring complications, she'd be in the hospital about 3 months. And the list of complications? It was long and potent, even without the respiratory syncytial virus that went around that spring, killing two of her comrades. I was nearly driven mad by the bells and buzzers in the NICU. I nearly drove the neonatologists mad by seeing and comprehending too much and too little. When there was a moment to talk, they wondered aloud about this odd Beast, the geriatrician, for whom there seemed to be no Beauty.

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