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On My Mind
June 6, 2011

Partnering Leadership

Author Affiliations

Author Affiliation: PolicyLab, Research Institute, Pediatric Advanced Care Team and Integrated Care Service, Departments of Medical Ethics and Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Arch Pediatr Adolesc Med. 2011;165(6):487-488. doi:10.1001/archpediatrics.2011.78

The red-haired infant rests on his mother's chest, his forehead tucked in the recess of her neck. The hospital room is quiet. With the lights off, only the gray morning glow from the northerly window illuminates the sleeping infant, but this suffices to reveal his head bobbing with the beat of his rapid breathing. He was born several months prematurely, and this is his third admission to our pediatric hospital. I am the attending physician, meeting him for the first time. As soon as my stethoscope touches his chest, my ears are filled with the din of crackles and wheezes. The hair around his forehead is damp with sweat, and the contours of his face are thin and sharply etched. Finishing my examination, I step back and sit in a nearby chair. His mother's eyes dart nervously from her son to me; she regards me warily. “I know what you're thinking,” she says. “You think he needs that operation, but he has nearly died so many times. I don't want it.”