While other children were dreaming about exotic careers as ballet dancers
or actors, Hilary Whyte knew she wanted to be a doctor. At the age of six,
she was diagnosed with a serious bone infection. She was in and out of hospitals
until she turned 23.
"I became very dependent on the nursing staff and the doctors. I was particularly
impressed by the caring nature of the doctors, which solidified my need to
do medicine."
At first, Whyte wanted to specialize in surgery. Although her professor
of surgery encouraged her, he also suggested that she reconsider her decision:
he knew Whyte also wanted to get married and have a family.
"He made me understand that I'd have to do more than every other surgeon
-- who was bound to be male -- in order to make the grade, but he didn't try
to dissuade me."
Her first job after graduating was as a pediatric surgical senior house
officer. It was here that she really became interested in pediatrics.
For the most part, neonatologists work in large urban centers. "There just
aren't enough babies who require neonatologists in the smaller rural towns.
If you want to be a neonatologist, you're going to live in a large city and
you're going to be attached to a large hospital, which is usually attached
to an academic institution or university," says Whyte.
"The notion is that neonates are for the most part healthy, and only about
six percent of those newborns will actually require any kind of specialized
pediatric assistance. Only about one percent will require real neonatal expertise,"
she explains.
There are two kinds of neonatologists: those who are situated in large
level-three teaching hospitals connected to universities, and those who are
associated with level-two hospitals.
"Academic neonatologists aren't only responsible for excellent clinical
care and performing at the cutting edge, but they're also mandated to do teaching
and research. Neonatologists who move into one of the level-two nurseries
will probably have a mixture of neonatal and pediatric practice, and they're
only responsible for the clinical care of their patients. They don't, in general,
do teaching and research."
One stressful aspect of neonatology is the high mortality rate. "After
many months on clinical service, you'll always have one death, and usually
an average of four to five deaths, that you have to deal with. It's very stressful.
The families need a lot of support and a lot of attention, and that's what
takes it out of you more than anything."
When Dr. Alan Hodson entered neonatology, it was an emerging field. "John
Kennedy's baby was born and had respiratory distress. There was a White House
conference on mothers and infants, and the National Institute for Child Health
was established, all in the early to mid-'60s. That put an enormous national
emphasis on mothers and babies, so there was a tremendous push to improve
neonatal mortality and morbidity. That's when I entered the field," he says.
"In addition to the reasons that enticed me into the field, there are the
general ones that still exist. You work with newborn babies, and you become
an advocate for them. You work with families and deal with a lot of different
problems, unlike other subspecialties. You deal with the lungs, heart, brain,
skin and infections, almost like a general practitioner, only with a limited
age group. That's very appealing, because there's a host of interesting, challenging
problems."
The technical advances in intensive care have progressed remarkably in
the past 10 to 15 years. At the time Hodson entered the field, the biggest
cause of illness and death in babies was lung disorders. The challenges now
are to decrease the long-term morbidity, or long-term problems, associated
with being born prematurely.
"As intensive care has improved, the expectation has arrived that there's
no limit to what can be done to salvage a baby. The biggest conflict is extreme
prematurity, with babies born barely halfway through pregnancy, where there's
an expectation that something can be done, yet those infants are at the highest
risk of dying or having permanent problems. This raises ethical issues, since
discontinuing life support for babies that are too small to live is probably
the most trying part of one's career in neonatology," says Hodson.
The flip side, says Hodson, is the wonderful power you have to save a baby.
Those advances carry you through the difficult times. Often a neonatologist
has the opportunity to see their patients years down the road.
"They come back for months or years to visit the neonatologist. They write,
send pictures and continue the thread. That's a very rewarding part. Rather
than discharging your patients forevermore and not knowing what happens, I
hear from parents who had babies 15 to 20 years ago!"