They say medicine is politics on a grand scale.
They say medicine is science seeped in the social.
It’s about humanity, say the voices.
But I wonder where the voices have gone.
When you little ones sleep at night,
Bundled tighter than the other babies cuddled next door,
Sniffling, sneezing, sleeping.
We call you the ISUMs:
Infants of Substance Using Mothers.
There are 3 of you,
But you each stay snuggled, solitary.
2 of you are custody of the ward.
Cuddles and custody don’t alliterate well.
One of you, soon home with mom,
And her methadone,
Replacing the opioids her body craves.
And what is best,
Little sneezing ones
Where and with whom will you grow strong,
To soothe your tremors, to wrap you warm
How to choose right vs. wrong.
Is right mom, opioid replacement?
Is right child with ministry who doesn’t accept babies over long holiday weekends?
Are these even the questions to ask?
What I do know,
Or think I know,
Or maybe just wonder. Ponder.
Is, where, in the 21st century, is our responsibility,
Our role as health care providers, as “healers”
To ask big questions,
About our world, our communities, our parents, our moms.
Where do the politics, the social, humanity fit.
Does the order “consult social work” suffice?
Signed, dated, chart closed and filed?
But today, at least,
I can report, concrete,
The NAS score.
For babies, 1, 2 and 3.
The score which guides morphine dosing to reduce withdrawal symptoms.
Sniffling, sneezing, tremors, high pitch cry.
The NAS score*.
The current morphine dose.
Weight gain, urine output, number of stools.
Do these numbers and facts suffice?
Replace recognition that 3 mom’s in our communities are coping,
Using substances deemed illegal by some,
But essential for others.
The voices asking why, how, when, what.
They are silent.
Questions of resiliency, supports, wellbeing mute.
Does our role end beyond white washed, blue tinged hospital walls?
After the last handwashing of the day?
I wonder where the voices have gone,
When I hear my attending ask:
“So what was the NAS score overnight?”
And I wonder where my voice has gone,
With the reply: “zero to 1,
All is well.
She’s medically clear”.
*The NAS score stands for the Neonatal Abstinence Score, which grades a baby’s withdrawal symptoms.