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The struggle to live and the fight to die
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They are no different than those who stepped aside from the wounded and robbed on the road to Jericho. They are todays passersby who might say, he should have known better. He could have taken the other route. - photo by Joseph Cramer, MD
Pediatrics is filled with contrasts.

There are the young and beautiful. There are the children who lost the genetic lottery. There are the well kids running around the clinics waiting room. There are others unable to move on their own.

There are newborns who struggle to live. There are teens who struggle to die. Once, at the same hospital, there was an infant born to a mother with gestational diabetes. The extra blood glucose in the womb environment caused the fetal pancreas to produce more insulin. At delivery, the sugar supply was cut off, literally. With surplus insulin, the babys glucose plummeted to nearly zero. The baby was sustained on high concentration and high volume of life supporting sugar.

Across the hall was a teenager who without medical intervention would have died from acetaminophen overdose. Tylenol and its generics can kill. Taken in significant excess, the drug destroys the liver, then the person. A liver transplant is the only option for survival. Thank goodness there is an antidote.

It is a study in contrast. The baby fought to live. The girl fought to die. The conflict was monumental

The newborn was the defendant in this trial. It was not the childs choice to have a pancreas that produced more insulin to stay even with the surplus from the mother.

The teenager was not the sole perpetrator in the struggle. This child had been exposed to an environment that was dangerous and didnt choose the circumstances any more than the hypoglycemic infant.

The teen lost a parent as a toddler, doesn't get along with the stepfather, has been bullied at school and called "fat" by so-called friends. The teen's amygdala, the center of emotions in the brain, reacted by producing more hormones of stress.

The pancreas and the amygdala do what they are supposed to do. One makes insulin in response to sugar. The other releases neurotransmitters in response to threats. Most feel compassion for the newborn. A lot feel contempt for the teenager.

But the teen vomiting from the overdose and flushed with antidote deserves the same commitment by society as the neonate with low sugars. They deserve the same treatment by insurance companies. They need to be understood with the same empathy.

There are those who argue as anti-Samaritans that the action by the teenager was voluntary, and the consequences should be suffered. They are no different than those who stepped aside from the wounded and robbed on the road to Jericho. They are todays passersby who might say, "The traveler should have known better. He could have taken the other route."

There is only one road to our human destinations. It is not the rocks and potholes in the path. It is what we do with and for our fellow travelers.

Pediatrics is a field of contrasts. Our concern for children should not be. We collectively need to care for the too much and the too little of brain chemicals as much as problems with too much insulin and too little glucose.
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