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Monday, September 6, 2010

Peter's Residency Application Essay


I had just finished my 3rd year OB/Gyn rotation and my wife, 23 weeks pregnant, and I were celebrating with a nice dinner. For 23 weeks we talked about names, made guesses regarding gender, dreamt about the future. We used adjectives such as "cute, "adorable", and "chubby." We planned for this baby, this child who was just beginning to show in my wife's profile. We loved. We laughed. We attempted to prepare our two-year-old son. We glowed. We didn't think "what if." We didn't use words like "viability", "ventilator" or "resuscitation." We didn't worry. We didn't falter. We just didn't know.

The drive from the restaurant was made firmly in medical mode. Just coming off my OB/GYN rotation only hours before, I was medically sanitized. "Preterm Premature Rupture of Membranes" was the proper medical term, but it did not begin to address the reality that was beginning to unfold. Clinically, I knew that at 23 weeks gestation, we were still shy of that magical term-a term I was quickly developing a strong distaste of-viability.

Four days later, two days past our "viability" threshold, we entered the OR. As a medical student, I had seen a C-section several times. I had been the one to hold the obligatory bladder blade more than once-many, many more times than once. The auditory cues were the same, but on the other side of that blue sheet, my wife's C-section didn't feel like the pattern I had come to know so well:

Time of Delivery: 0213
Sound of Baby's first cry

Instead, "Time of Delivery" and the OR door swinging shut were simultaneous. The air rang silent. The Neonatologist had rushed our daughter out to begin resuscitation.

Thus began our introduction to the Neonatal Intensive Care Unit. That evening was Charlotte's first in the NICU. She weighed in at 560 grams. That evening, we just didn't know the level of her viability.

In the coming days, weeks, and months, my wife and I enrolled in hands on courses in Patent Ductus Arteriosis, Chronic Lung Disease, High Output Cardiac Failure, Retinopathy of Prematurity, and Retinal Detachment. We've had crash courses in ventilator settings and speech pathology. We learned to appreciate small things: 0.5mL enteral feeds, nights uninterrupted by phone calls and days when nothing changed.

I've learned that medicine is more than a white coat and a stethoscope. I learned, for me at least, what it means to be on the other end of a medical school education. I've learned that "viability" doesn't limit itself to micro-preemies or ELBW's-instead, it applies to us all. Viability means having the ability to grow, improve, and develop. As doctors, as patients, as parents, we are all seeking to be viable; to stretch our ability and overcome our weaknesses.

Throughout this experience, I've processed everything through my medical filter. But as a parent I've come to see how important seemingly routine lab values can be to a family. How test results can bring comfort, and how any answer, good or bad, is better than just not knowing. I've experienced how humbling it can be to have such little power over the outcome of your child. I've known the agony of a parent deciding between continuing the fight to keep a child with you, or letting them go be with God. I've known the long hours of doing nothing more than rocking a sick infant; an infant who weighs more in wires and lines than in body mass.

This knowledge impacts my actions. Working with families, I feel a responsibility. I know what it means to have a doctor fighting for your child, and I have committed to being that doctor for others. Just as I bring my medical knowledge to the table with Charlotte, I bring my personal experience with me as I interact with patients.

Once a week during this ordeal I had the opportunity to sit down with the Neonatologist and round on my daughter. He seemed to know that I needed this, this chance to have some control, even if it was to just agree with his plan for the week. As I have explored the many fields of medicine during my rotations I have been touched by Pediatrics. Whether it is helping a mother learn to breastfeed, or taking the time to form a bond with the teenager who is headed down a difficult road, Pediatricians play an invaluable role. I know that as a Pediatrician, I would do more than treat an illness-I would have the chance to heal a person.

I began medical school with the intention of avoiding 'snotty nosed' kids, at any cost. I spent the winter cold and flu season seeing many of them in an inner city clinic. To my surprise, and with certain humility, I found that treating children is where my medical knowledge makes the most sense. I've learned that it is treating those very children that brings me the most joy, that challenges my intellect, that pushes me to become more viable. More viable as a doctor, more viable as a person.

This evening, is Charlotte's 186th spent in the NICU.
This evening, my daughter weighed in at 4500 grams.
This evening, we are both continuing to prove our viability.


  1. Wow...that is a powerful essay. My baby just got out of the NICU, and I would LOVE to have your husband as her pediatrician. When I was going through my horrible pregnancy, I wished that my OB could understand what I was going through. I think that Peter's experience with his daughter will give him such value as a doctor. I see many doctors, and it is always the ones with empathy who are able to help me the most. Thank you for sharing the essay. I love how its theme is "viability."

  2. I agree with everything that Noelle said. Thank you for sharing. I am now adding Peter getting into the residency of his dreams to my list of daily positive thoughts and prayers for the Knickerbocker family. You all deserve it and every micro-preemie, preterm and full-term child deserve to have someone like Peter caring for them. I actually came on tonight to say that I am hoping that tomorrow brings some movement on Charlotte's care after this holiday weekend.

  3. I remember taking care of Charlotte the day after she was born and asking you which area of medicine you had an interest in. When you said neo or peds, I told you that your experience would make or break that option. I am so glad that it made you see that there is a light somewhere in the dark, scary days that all family members of patients encounter during the journey of having a chronic family member. Although most of your patients won't be as chronic as Charlotte, you have found what it takes to be compassionate, empathetic and will have the ability to weed through all of the muck. And most importantly, you know that it's ok NOT to know the answers to everything. It takes a big person to say "I don't know". The path you have travelled for almost 7 months has given you the vision and wisdom that will carry you through all the challenges that medical school and residency brings. And you have realized that you are a much better person because of it. Good Luck!!!

  4. What a great essay. It brought tears to my eyes. I'm sure it will stand out and Peter will get the residency he's hoping for. Thinking of you!

  5. What a blessing you will be to your patients and their families, Peter. Thanks to both you and Amanda for allowing us to see your vulnerabilities as well as your virtues.

  6. Pete,
    This was amazing! Really well done. Are you going through the application process now? Best of luck.
    Dr. L

  7. Just found your blog...and I LOVE it.

    This gave me chills and made me tear up. My daughter was born @ 26 weeks and she is still fighting hard in the nicu. I think his personal experience will truly help the families he treats and make him a wonderful doctor. Bless you and your family!