Blog Book Review. Between Expectations: Lessons from a Pediatric Residency

Death is an obvious answer to the question of what it is about medicine and pediatrics in particular that can make its practice difficult, but death itself is simple. It is a single moment, and a moment, no matter how painful the flash of grief that accompanies it, is easy enough to endure. Death is nothing compared to all the moments that lead up to it and those that follow.

In her new memoir, Between Expectations: Lessons from a Pediatric Residency (Free Press, 2011), Meghan MacLean Weir shares a number of such moments that lead up to and follow the death of a child. Weir offers a fascinating perspective, that of the doctor – the person always present in the hospital room with family and loved ones, yet often considered too objective to be emotionally attached. With her book, Weir lets readers know just how emotional doctors can be.

Consider her reaction to a child requesting a pinky swear that he wouldn’t die that night:

I am overwhelmed with the singularity of the moment. I feel the connection between myself and this creature before me, still new and untested, but profound in his depth. This is what they talk about, those physicians who have come to the end of their careers, when they say that it has been fulfilling in a way that no other job can ever be.

As an ER pediatrician, Weir treats the smallest of patients while their parents are at their most vulnerable. She maintains empathy and respect for the parents, but enlightens readers to the silent reflections of doctors. For example, after she speaks to the parents of a child clinging to life in the NICU, Weir writes that they must not fully realize, or else they are in denial about the severe challenges their baby will face if he survives, and she seems to judge their irrational actions to keep their child alive at all cost.

Yet, when another couple decides to let their baby go, Weir finds the scene unbearable:

Even though I had asked to come as an observer – so that should it ever be my job to oversee such a tragedy, I would know the things that are right to do and say – I cannot stand the cluttered silence.

“Did you give her a name?” I ask her mother.

“We named her Candi. With an ‘i’.”

It is a wretched name, but I lie without guilt as I say, “What a wonderful choice.”

The baby’s heartbeat drops from 140 to 60 and then to 40, and Weir says to the crying mother, “She’s so beautiful,” reflecting on the description as “both a falsehood and a truth.” As this passage occurs in the first half of the book, readers might grapple with the equivocation of a dying baby and beauty. Undoubtedly, a career as a doctor includes death, but does it also entail beauty?

By the end of Between Expectations, readers will likely answer yes because they will have shared the transformation Weir experienced during her residency. There is tremendous pain in accepting that a child will enter life seriously ill, yet there is also beauty in seeing that child loved and cared for unconditionally. Indeed, Weir considers it the privilege of a doctor to witness love in its purest form. Here she reflects on the fate of a premature baby and his mother:

I know that it is possible that he will live into his twenties or even beyond, that there might be decades of diaper changes and tube feedings and around-the-clock care ahead. And while I know that it will certainly be difficult, I feel strangely confident that Kay will still have the strength throughout it all to remain at his side.

Albert Einstein is oft-quoted as saying, “There are only two ways to live your life. One is as though nothing is a miracle. The other is as if everything is.” It’s obvious which Meghan MacLean Weir has chosen.