Our privilege is sacred

I believes that we who have taken the "Oath" to practice our sacred profession of medicine and we who have committed ourselves to the healing arts must do so with the imperative to respect the sanctity of health for all those we treat - with a sense of high privilege-for they are the flesh and blood and souls of our humanity - past, present and future - and we, by our choice, their guardians. I, through my writings, poems, personal thoughts and unique programs strive to promote these tenets.


Our words are songs

The impact of words is universal. Words particularly in the form of poetry can uniquely bridge the chasm of what to say and what is felt at significant times in all of our lives. Through metaphor and allusion, rhyming and meter; for eulogy and celebration; for love, understanding and hope, poetry matters significantly. Poetry enables me to ask why even when we already understand how. It permits me as a Doctor of Medicine, 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. It has been my platform to tell my 'stories', to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man". We as healthcare professionals have a need and obligation to care for others. Whether in academic, research or clinical practice, laboratory medicine or diagnostic imaging, the healthcare professionals' role is to bring comfort and to heal. From such healing comes self-reward, self-fulfillment and honor. If we are surrounded by despair and inequities and have the opportunity to help with their dissolution, it is our obligation to do so. Such has been my mission as a physician, an obstetrician, through my work and my poetry. If one person, one family, can be helped or can gather hope through the words we write and say, it can bring reward equal to the healing with our hands and minds. Hope is a singular gift we must never destroy in ourselves. Poetry is its instrument whose music can be its enabler. Words we write, words we read, and words we hear can serve as an invaluable source of healing. Words are songs from our hearts and can be "songs of hope, songs for hope"

Maternl shares my original projects, personal words, thoughts and poetry which above all enables me to ask why even when we already understand how. Poetry permits me as a doctor of medicine, 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. It has been my platform to tell my 'stories', to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man".

Maternl is intended for all in need of comfort, healing and solace including mothers and families who have experienced infertility, miscarriages, stillbirths and neonatal deaths for when we are ill, vulnerable and in need of care, although our spirits may fade and our viscera may bleed, we must be enabled by the agents of our humanity empowered by our words and language and ancestral songs of promise.

Maternl acknowledges that there remains inexorable suffering which accompanies tribulations not only from inevitable limits of new medical technologies but from pervasive disparities which exist to deny all to have access to and to be recipient of one standard of care; disparities defined by the social determinants of health, limited or no access to care, unconscious bias, lack of advocacy and "avoidance and dismisal rather than involvement and immersion". The paradox of our societies to both cure and cause pain is real and evident. Recognizing and addressing losses that parents experience through miscarriages, stillbirths and neonatal deaths (my life's work as an obstetrician) is my overlying mission as I believe it can serve as a paradigm for healing for all patients of all health professionals.

Moses Maimonides, "the most important Jewish philosopher of the Middle Ages" wrote "The eternal providence has appointed me to watch over the life and health of Thy creatures... my lofty aim of doing good to Thy children...may I never see in the patient anything but a fellow creature in pain" ²

Both citations above speak of patients as "fellows" and "human[sic] creatures and children...". This must commit us who have taken the "Oath" to practice our sacred profession of medicine with an imperative to respect the sanctity of life and health for all those we treat-with a sense of high privilege- for they are the flesh and blood and souls of all humanity - past, present and future-and we, by our choice, their guardians.

Maternl© is about the human experience, hope and despair; about celebration and sorrow. Maternl© recognizes that caring for the well-being and the illnesses of patients and their families is to accept that medical science in all its depth and possibilities is not precise and that the human mind and flesh are perishable. We are today steeped in myriad medical technologies that in themselves bring hope to previously hopeless conditions and pathologies. We must acknowledge that there remains inexorable suffering which accompanies failures and tribulations not only of these new medical technologies but of pervasive disparities which exist to deny access to and recipient of one standard of care for all, disparities defined by the social determinants of health. The paradox of our societies to both cure and cause pain is real and evident. Recognizing and addressing the losses that parents experience through miscarriages, stillbirths and neonatal deaths is our overlying mission as it serves as a paradigm for healing when we cannot cure.

"I believe that we as practitioners and guardians of humanity's health, have been granted by oath and by ethic the privilege to examine and treat, to counsel and advise our fellow human beings and we must never abandon the souls of all patients seeking our care."

A Brief Personal Thought
I am first a physician, a distant disciple of Aesculapius and Hippocrates³; a clinician, a teacher, and a student. I am an Obstetrician. I stand before my patients⁴ and facilitate their births. I share their joys; I feel their pains. Yet, caring for the well-being and the illnesses of patients and their families is to accept that medical science in all its depth and possibilities is not precise and that the human mind and flesh are perishable. We are today steeped in myriad medical technologies that in themselves bring hope to previously hopeless conditions and pathologies. Yet there remains inexorable suffering which accompanies failures and tribulations not only of these new medical technologies but of pervasive disparities which exist to deny access to and recipient of one standard of care for all, disparities defined by the social determinants of health:⁵ the paradox of our societies to both cure and cause pain which is real and evident.

I believe that we as practitioners and guardians of humanity's health, have been granted by oath and by ethic the privilege to examine and treat, to counsel and advise our fellow human beings and we must never abandon the souls of all patients seeking our care. There is no place for bias or prejudice or disparate care in our healthcare systems. I have tried in my half-century of caring for patients to follow this philosophy. Now, no longer in clinical practice, I have turned my passion and energies to creating this platform, Maternl©. It is my hope that Maternl© will propagate and preserve these tenets.

Prociedo⁶
Going forward (l)

Today are times of much despair
Yet times of great hope
To affirm our oath
As unfiltered reason and purpose
Rush in our blood
Every pulse a wave
Approaching distant shores
To leave our prejudice behind
To fade into vapors
As common as fog
And guide us to plant
Roots to bond our humanhood and
Vines to grow our brotherhood
As we go forth into tomorrow.

__________________________________
¹ Sherwin Nuland, MD. From Preface, Parenthood Lost. Berman, 2001.
² Excerpted from Dalhousie University Libraries: https://dal.ca.libguides.com/c.php?g=256990&p=1717827
³In Greek mythology, "Aesculapius, son of Apollo, the god of healing, was a famous physician. Hippocrates, was a member of the Asclepiadae- priest physicians whose origins may be traced to the mythical personage, Aesculapius"
⁴Obstare from the Latin meaning "To Stand before"; the root word of Obstetrics
⁵ "The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries." https://www.who.int/social_determinants/sdh_definition/en/
⁶ A poem defined by our times, September, 2020.

Words and Poetry

"Poems are not just feathers drifting into the Grand Canyon; they can make a real connection with another mind and heart"
Leisel Mueller, personal communication

The impact of words is universal. Words particularly in the form of poetry can uniquely bridge the chasm of what to say and what is felt at significant times in all of our lives. Through metaphor and allusion, rhyming and meter; for eulogy and celebration; for love, understanding and hope, poetry matters significantly. Poetry enables me to ask why even when we already understand how. It permits me as a Doctor of Medicine, 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. It has been my platform to tell my 'stories', to honor my patients, my friends, my family and indeed, the essence of humanity, the "family of man". We as healthcare professionals have a need and obligation to care for others. Whether in academic, research or clinical practice, laboratory medicine or diagnostic imaging, the healthcare professionals' role is to bring comfort and to heal. From such healing comes self-reward, self-fulfillment and honor. If we are surrounded by despair and inequities and have the opportunity to help with their dissolution, it is our obligation to do so. Such has been my mission as a physician, an obstetrician, through my work and my poetry. If one person, one family, can be helped or can gather hope through the words we write and say, it can bring reward equal to the healing with our hands and minds. Hope is a singular gift we must never destroy in ourselves. Poetry is its instrument whose music can be its enabler. Words we write, words we read, and words we hear can serve as an invaluable source of healing. Words are songs from our hearts and can be "songs of hope, songs for hope" My Poetry is about hope and despair; about celebration and sorrow. But mostly, it is about hope. Forms of expression implicit in symbolic language; poetry and verse, song, prayer and ritual, have served a role in all cultures and societies to dispel the tears and foster the healing of death and human loss, suffering and despair. Why does poetry triumph as a source of enduring inspiration and hope?

Though our spirits may fade and our viscera bleed, we are enabled by the agents of our humanity empowered by ancestral song and promise (Berman, 1999)

Comfort may be achieved through the transfer of the poet's feelings into the reader or listener's mind. It transports the reader from the distractions and influences of the outside world inward to the internal rhythms and solace of the personal soul. The poet becomes a healer and his poetry his staff. Through verse and meter, free of inhibition yet full with expression, the poet may articulate a sensitivity and empathy and provoke this introspection and inner peace. A poem is transformed into a message of hope. There is wonderment and magic in the words of a poem. Each word is selected for its individual meaning within the context of the entire poem. A few properly selected words can move the reader to tears and awaken the primal emotions of joy, promise, despair and hope. A poet should evoke emotion in his work and write as if each poem is written with the poet's last words.

The language of poetry, within the broader context of its 'parent body' (literature,) has always had as its great themes, love, loss and death. The inclusion of hope to these thematic elements is worthwhile if not essential for, (as humans) we have the capacity to bring hope to a despair that is uniquely created by our humanity and our human conditions.

As an Obstetrician, my professional career has involved a striving to bring comfort and healing to children, born and yet to born, and to mothers through their years of childbearing and beyond. It has been the cause in my life. I have been uplifted by the triumphs of birth and healing and depressed by the failures. Yet I have always tried to look beyond the failures in search of the triumphs. I have counseled patients at the darkest times of their lives, when their children have died, and I have turned to the comfort of personal reflection, poetry and self-expression to better help me help my patients. I have learned that by writing down thoughts which might elucidate my feelings more clearly than the spoken word, I have become a better physician.

"By making us stop for a moment, poetry gives us an opportunity to think about ourselves as human beings on this planet and what we mean to each other."
Rita Dove

"Only those within whose own consciousness the suns rise and set, the leaves burgeon and wither,can be said to be aware of what living is."
Joseph Wood Krutch

Some thoughts about caring for the
loss of a pregnancy or newborn

In solemn silence we walk the woods
beneath the boughs of willows, wailing

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.

We are not parents without our children, and when our children, conceived through our love and nurtured through our bodies and our spirits, are lost to death, we remain parents forever. There is such remorse when a child dies or a pregnancy fails. With each, a part of our own humanity is lost, never to be found. The need to reach out to others is both inherent and acquired. There is a "beauty and a tenderness that man can give to man.” Through family nurturing and family values, children grow to appreciate that without thoughtfulness for others, their motives throughout their lives will be selfish and unfulfilling. Indeed, we all have a need and an obligation to care for others and I believe Physicians are in a foremost position to carry out these deeds: bring comfort and to heal others. We as human beings can be distinguished from our ancestors by our capacity to think, to speak, to choose, to consciously procreate, understand the value of our actions, and have the ability to ‘hope”. Thus, I believe hope is a singular gift we must never destroy. The profundity of a parent's grief when their child has died has remained incontrovertible through the ages. There has not been, nor is there now, one common and standardized way to manage the recovery from such grief, for its shadow has been, and will be, indelibly imprinted in the minds and souls of these parents. A child is not expected to die before his or her parents. The natural processes of birth, life, and death should follow in an orderly and rational sequence through one's lifetime. Any death other than one from old age, after a rich and fulfilling life, is premature. When parents see their child die, or carry the burden of an unborn child's demise, or for purpose and reason must end a pregnancy, they live with this disruption of natural order forever.

"...The woman conceives. As a mother she is another person than the women without child. She carries the fruit of the night...in her body. Something grows. Something grows into her life that never again departs from it. She is a mother. She is and remains a mother even though her child dies, though all her children die. For at one time she carried the child under her heart. And it does not go out of her heart ever again. Not even when it is dead..." Anonymous

Maternl is a place for comfort, empathy, support and hope if you should experience a miscarriage, stillbirth or newborn death. Here you will find original writings, poems, sharing and bereavement resources and excerpts from my book: Parenthood Lost.




Read
Finding the right words after a pregnancy loss
An original article written by Dr. Berman and published in Contemporary Ob-Gyn, March, 2009.

Join
The Maternl Pregnancy Loss Community

"Though strangers we may be, we are all connected by the loss of a child, and that makes us all soulmates..."
( from a Maternl / Hygeia user )