I remember how the attending explained to a new dad an abnormal physical exam finding in his newborn son. The dad started to cry. The exam abnormality wasn’t so severe or concerning to prompt his sadness, but rather embarrassing for the father as a physician himself. “That’s my specialty,” the dad confessed to us. He was a senior fellow in the subspecialty that would treat his son’s condition. “How could I have missed this?” He was not only embarrassed that we had to report this finding to him but confused about why he hadn’t seen what was actually quite obvious, even to a third year medical student like myself.
At that time, I thought the fellow had missed his son’s condition because he was a sleep-deprived new parent. I wouldn’t really understand until years later when I found myself in his shoes.
N was in the NICU for a few days when his nurse informed me that his bilirubin was high. In disbelief, I inquired about what the value was and found that it was sixteen. My first response was, “wow.” My surprise did not come from how high the number was, but rather that I had been oblivious to his apparent jaundice, which this lab value confirmed. After all, I had spent the past three years of residency judging newborn’s jaundice by their skin color, interpreting these bilirubin labs, and ordering phototherapy. I had given at least half a dozen talks to medical students on this very topic, explaining the pathophysiology of hyperbilirubinemia. I considered this one of the basics of pediatrics, my chosen career.
I knew enough about this disease process to know that N was relatively high risk, both from his prematurity and history of breastfeeding. Had I been his physician, this would have been on my radar, but as his mother, it completely took me by surprise. I began to understand the embarrassment and confusion that the fellow had shown years before.
I keep this photo of a jaundiced N on my desk. It reminds me of my error in recognizing his obvious yellow glow. Instead of feeling shame over it though, I have come to see it as a source of pride. I am not his physician, I am simply his mom and this situation is exactly why I make that distinction. Yes, I now see the jaundice, but I understand why I couldn’t see it in the NICU. No matter what my training should teach me about my child, when I see him, he will always look perfect.