The Child Inside
Dr. Michael Cunningham
In the summer of 1989, I was a second year pediatric resident atChildren’s. I was doing my first Infant Intensive Care Unit (IICU)rotation. On evenings and weekends, senior resident physicians wouldcome in and help with the workload of admitting and caring forcritically ill infants. I loved the IICU — I liked the challenge ofcaring for such critically ill children and I enjoyed the type of carethat they required. I had recently decided that I would go intocardiology for much the same reasons. I liked the intensity of care andthe technology used to diagnose and treat children with cardiacmalformations.
It was a Saturday afternoon and the IICUwas very busy, the census was high and there were several very sickchildren. We had a system of alternating admissions between the juniorand senior residents so as to even the workload. I had just admitted apatient and gotten them stabilized when another expected admissionrolled in the door. Not being my admit, I did not pay too muchattention and let the senior resident do her work. A few minutes latershe came over to the desk and said, “Why don’t you take thisadmission?” I looked at her incredulously and said, “I just had anadmit; it’s your turn.”
Her reply was the beginning ofwhat has become a remarkable career for me. She simply said, “You do sowell with cases and families like these.” I walked to the bedside andsaw an infant with multiple malformations of the face and body andrealized she was right. It was at that moment that she helped merealize that I enjoyed helping families that had been dealt thishorrible blow. I could see beyond the clefts, missing ears andmisshapen heads and see the child inside. I could help familiesunderstand what it all meant and how we could help. I never take away afamily’s hope but at the same time I am honest about the challengesthat they and their child will face.
Every mother worriesthat something is wrong with her unborn child, and yet we all expect toget the perfect infant, the “Gerber baby.” None of my families get theGerber baby; they have each lost the infant that they expected. I get agreat deal of satisfaction helping families deal with this loss andhelping them move on to what is necessary to help their child lead thebest life possible. It is ironic how it turned out for me. I was headedtoward a career of treating critically ill children withtechnologically advanced tools. Now my tools are my eyes, my hands andmy time.
Now as the medical director of Children’sCraniofacial Center, I can not only help my patients, but all thosetreated in our center through the advancement of superbinterdisciplinary care. Through this clinical care and our researchvision, we reach many more families than would otherwise be possible.We have been given a pretty hefty charge — we treat the faces ofchildren. Consider what your face is to you. If I were to hand youthree photos, one of your hand, one of your shoulder and one of yourface, and I asked you to describe what the pictures were, you wouldreply “My hand,” “My shoulder,” “Me.” You would not call a picture ofyour face “My face”— it is not anatomy, it is you. We treat what peopleknow as themselves — an awesome responsibility.
I amthankful for the tremendous support Children’s Hospital has given meduring my training and career development. Over the past seven years asdirector of the Craniofacial Center, Children’s Hospital has given meand my staff the ability to create what most in the country feel is themodel for craniofacial care. We now have over 40 faculty and staffdedicated to the care of children with facial differences and theirfamilies. Speaking for all the members of the Craniofacial Center, weare grateful for the support that Children’s has provided and lookforward to the realization of our current clinical and researchinitiatives.