Mother’s lap!

Is that the abode of solace for her dying baby?

Author: Dr Lulu Mathews
Program Director, Academics, Institute of Palliative Medicine(WHOCC for Community Participation in Palliative Care and Long-term Care), Kozhikode, Kerala.

Where would you like to die? In whose arms?

This question when posed to an adult, you are unlikely to get a prompt reply. If posed to a child? Nobody will dare to ask such a question to a child!

From my experience of being with children from 1978 onwards as a practising paediatrician, I have my own opinion based on my observations.

When you want to console a new-born screaming with tummy discomfort, you put him in prone position and pat his back and wow the baby stops screaming. Similarly how well a baby sleeps when put in the prone position. This is so because this is the posture the baby is in utero. Similarly even if the mother crows a song rather than croons or sings, the baby sleeps because that is the voice which is most familiar to a baby.

Hence I am sure the baby would like to bid good bye in the mother’s lap. In the process making the mother happy and without ill feelings. In my capacity as HOD Paediatrics in a busy Government Medical College, I have often seen mothers peeping in through key holes, window panes and door cracks when their babies are admitted in the Intensive Care Units. Mothers are most happy when their babies are under their care. Mothers know however good the Medical Team is, they are unlikely to understand the emotional needs of their kids. I have often been mesmerised by the sudden clinical improvement in kids when “visited” by their mothers in ICUs.

After a baby’s death in ICU, what makes a mother most unhappy is that she was not present with her baby at the time of death. She has come to terms with her child’s illness and has already accepted the reality of death. But not to say goodbye to her child is something which she cannot bear. Did my child look around for me? Did she ask for me? Did you give her water to drink? Was she hungry? Was she thirsty?

Hearing these queries, we would think mother would like to get her baby out of ICU. In most of the situations, that is not to be. She wants “everything“ to be done for her child, and she believes it is being given in the ICU. But that “everything” includes her presence in ICU.

To overcome this dichotomy what I did as HOD was to set apart 2 beds in ICU for the EoL care of children and to allow the mother to be with her child as carer. Nurses were not in favour because they felt the mothers were constantly “complaining “. But are they really complaining? No they aren’t. A mother is only pointing out the so called flimsy errors because she wants “everything” to be done for her child. What about the changes in the child when the mother is beside? Decreasing tendency of tachycardia, tachypnoea, increasing level of arousal.

Before I close, I will ever remember the 9 year old who died in her mother’s lap after requesting her neighbour, her mother’s friend to marry her mother because she did not want her mother (a single parent) to be lonely after her only child’s death.

Thanks Theresa Sam Cherian for the beautiful portrayal of the mother and baby.

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