The Child Inside

The Child Inside

Dr. Michael Cunningham

In the summer of 1989, I was a second year pediatric resident at Children’s. I was doing my first Infant Intensive Care Unit (IICU) rotation. On evenings and weekends, senior resident physicians would come in and help with the workload of admitting and caring for critically ill infants. I loved the IICU — I liked the challenge of caring for such critically ill children and I enjoyed the type of care that they required. I had recently decided that I would go into cardiology for much the same reasons. I liked the intensity of care and the technology used to diagnose and treat children with cardiac malformations.

It was a Saturday afternoon and the IICU was very busy, the census was high and there were several very sick children. We had a system of alternating admissions between the junior and senior residents so as to even the workload. I had just admitted a patient and gotten them stabilized when another expected admission rolled in the door. Not being my admit, I did not pay too much attention and let the senior resident do her work. A few minutes later she came over to the desk and said, “Why don’t you take this admission?” I looked at her incredulously and said, “I just had an admit; it’s your turn.”

Her reply was the beginning of what has become a remarkable career for me. She simply said, “You do so well with cases and families like these.” I walked to the bedside and saw an infant with multiple malformations of the face and body and realized she was right. It was at that moment that she helped me realize that I enjoyed helping families that had been dealt this horrible blow. I could see beyond the clefts, missing ears and misshapen heads and see the child inside. I could help families understand what it all meant and how we could help. I never take away a family’s hope but at the same time I am honest about the challenges that they and their child will face.

Every mother worries that something is wrong with her unborn child, and yet we all expect to get the perfect infant, the “Gerber baby.” None of my families get the Gerber baby; they have each lost the infant that they expected. I get a great deal of satisfaction helping families deal with this loss and helping them move on to what is necessary to help their child lead the best life possible. It is ironic how it turned out for me. I was headed toward a career of treating critically ill children with technologically advanced tools. Now my tools are my eyes, my hands and my time.

Now as the medical director of Children’s Craniofacial Center, I can not only help my patients, but all those treated in our center through the advancement of superb interdisciplinary care. Through this clinical care and our research vision, we reach many more families than would otherwise be possible. We have been given a pretty hefty charge — we treat the faces of children. Consider what your face is to you. If I were to hand you three photos, one of your hand, one of your shoulder and one of your face, and I asked you to describe what the pictures were, you would reply “My hand,” “My shoulder,” “Me.” You would not call a picture of your face “My face”— it is not anatomy, it is you. We treat what people know as themselves — an awesome responsibility.

I am thankful for the tremendous support Children’s Hospital has given me during my training and career development. Over the past seven years as director of the Craniofacial Center, Children’s Hospital has given me and my staff the ability to create what most in the country feel is the model for craniofacial care. We now have over 40 faculty and staff dedicated to the care of children with facial differences and their families. Speaking for all the members of the Craniofacial Center, we are grateful for the support that Children’s has provided and look forward to the realization of our current clinical and research initiatives.