What We're Willing to Carry: A Different Kind of Christmas Story đ
đ This year, Christmas arrived at my house the way so many things arrive in a household with small children: not with trumpets, but with bodily fluids.
Last week I finished a call shift, came home, and did what I do when Iâm trying to be faithful to the most basic ethic of medicineâreduce preventable harm. I got vaccinated. COVID and flu. My body responded the way bodies sometimes do when theyâre asked to practice for an enemy: fever, aches, that bruised, heavy feeling like your immune system is running drills at full volume.
And because I can already hear the familiar chorus that shows up every winter: no, the flu vaccine did not give us the flu. Thatâs not how the flu shot works. Feeling crummy afterward is an immune responseâyour body learning, rehearsing, building recognition. What came after was the actual virus, delivered with the casual efficiency only children can manage, because kids are tiny, beloved vectors and they do not care about anyoneâs timing.
My daughter got the real flu. Not the polite kind that makes you tired and then politely exits. The kind that makes a home feel like itâs under siege. Fever. Vomiting. That awful combination of lethargy and irritability that makes a child cling and fight at the same time. Then it moved through the rest of us in its own order, like it was checking names off a list.
đ€ Before you have children, being sick can contain a strange little permission slip.
You can lie down. You can call out. You can let the world proceed without you for a day or two while you surrender to the fact that you are a mammal with limits.
Being sick with kidsâespecially sick kidsâcomes with no permission. There is no sanctioned rest. Care doesnât pause because youâre feverish. It doesnât soften because your stomach is rolling. It just keeps arriving in new forms: another cup of water, another towel, another load of laundry, another child who needs to be held at the exact moment you feel least capable of holding anyone.
We have a soaking tub in our bathroomâone of those domestic fantasies that implies serenity if you ever live long enough to deserve it. This week it became a staging ground for wet linens and ruined blankets, an unintentional monument to the volume of mess that can be generated when three small bodies decide to revolt at once. My husband and I were both sick, both trying to keep the house upright, both searching for patience inside bodies that had none left. And toddlers, when theyâre sick, can be astonishingly unkindânot because they are cruel, but because they are suffering and have no words for it. They need you. They fight you. They demand you. You love them fiercely and, if youâre honest, you also stare into the middle distance at some point and think: I cannot do this for one more hour.
We did what most families do when the situation is both frightening and exhausting: we escalated to whatever tools we had. Tamiflu. Fluids. Rest in fractured minutes we stole from the night. Two of the three kids began to improve. One lingered with fevers, flirting with that familiar pattern parents learn the hard wayâwhen recovery is real, but incomplete, and a secondary infection tries to write its own sequel. Still, the trajectory tilted in the right direction. Christmas, in our house, got rescheduled. It turns out holidays are more flexible than we pretend. The kids will still get their magic; it just wonât arrive on the calendarâs schedule.
A traditional gratitude essay would end here. Chaos, then recovery, then a tidy moral about resilience and perspective.
But this year, gratitude didnât arrive tidy.
đ„ Because while I was living through my own domestic collapse, I was also on call. I was also doing my job as an OB-GYN.
And I found myselfâagainâin one of the most ethically brutal spaces in obstetrics: the periviable window.
Details in the clinical vignette that follows have been intentionally altered and blended to protect patient privacy.
Periviability is the borderland. Itâs the stretch of pregnancy where modern medicine can sometimes sustain life outside the womb, but not reliably, not without profound risk, and not without consequences that can reshape an entire familyâs future. Itâs where certainty becomes a luxury no one can afford. Itâs where every sentence you say as a physician feels like it weighs too much, because the person in front of you isnât asking for a lecture. Theyâre asking for a way to survive the next decision.
A young patient came in uncomfortableâscared, trying to be brave, trying to understand what her body was doing. She had a cerclage, a stitch placed in the cervix when the cervix begins to shorten too early in pregnancy. Cervical insufficiency is one of those diagnoses that reminds you how humbling reproduction is: we can describe the pattern and we can intervene, but we still canât always explain why one body begins to change early while another holds steady. We treat with what we haveâprogesterone, cerclage, monitoringâknowing that sometimes the interventions slow the process and sometimes they donât. Sometimes the body keeps moving toward labor anyway, and all you can do is try to read the signals with enough honesty to keep people safe.
The work starts in the most human, unglamorous way. You ask permission. You explain what youâre doing. You go slowly because fear tightens everything. You tell her to hold your hand and you mean it. You collect swabs to look for infection, because infection can make the cervix and uterus âunhappyâ and push the body toward labor. You try to determine whether membranes might be ruptured, because sometimes the water breaks before dilation becomes obvious. You watch the difference between mucus, medication residue, and amniotic fluid, knowing that at this gestational age, the difference is not academic. You speak carefully, because the wrong kind of reassurance becomes betrayal later, but the wrong kind of alarm becomes trauma now.
Then you run headlong into the reality that makes periviability what it is: time. Gestational age. Thresholds.
Not because babies are morally different on different days. Because physiology is. Because lungs and brains do not mature on a timeline we can negotiate with. Because NICUsâno matter how skilledâare limited by biology and by the capabilities of their particular institution. Many hospitals do not offer resuscitation under a certain gestational age. Some specialized centers will consider more earlier than others. Most modern facilities mark the midâtwenty-week range as viability in the practical sense: with intensive care, there is a reasonable chance of leaving the hospital with a living child. Between those numbers lives the grayâwhere outcomes vary, where facility policies differ, where one zip code can determine what âoptionsâ even means.
âïž In that gray zone, counseling becomes an exercise in ethical precision.
You have to explain the reality without making the family feel like they are being asked to play God. You have to name that there is no right or wrong choice in the abstractâonly choices that align more or less with a familyâs values, resources, and tolerance for risk and suffering. You have to tell them the questions they may soon be asked: Do you want everything done? Do you want interventions only when there is a meaningful chance of benefit? Are you trying to maximize survival at any cost, or are you trying to minimize suffering, even if that means accepting limits?
You also have to tell the truth that people rarely say out loud in public, because it makes everyone uncomfortable: sometimes âdoing everythingâ can be its own kind of harm. Not because the baby is not worth it. Not because the family is wrong to hope. But because at the edge of viability, aggressive intervention can create suffering without creating meaningful survival. And even when survival is achieved, the quality of that survival can range from remarkably intact to profoundly impaired. There are children who surprise us. There are children who do not. In this window, we cannot guarantee which story a family will get.
This is where the counseling I did that night settled into my bones in a new way. Because I wasnât only thinking about survival curves or NICU statistics. I was thinking about what comes after the hospitalâif there is an after.
The part the public often misses is that periviability doesnât just create a clinical outcome. It creates a life. A long one, sometimes. A life that may be shaped by chronic lung disease, feeding tubes, repeated hospitalizations, severe neurodevelopmental impairment, dependence on machines and caregivers, pain we canât fully eliminate, needs that do not fade with time. Thatâs not every case, but it is a real possibility, and the earlier the gestational age, the more that possibility becomes central. Some people hear that and still choose maximal intervention. That is their right. Many people, once they truly understand what it can mean, choose something else. What matters is that the choice is made with honesty, not with slogans.
And then thereâs the logistical reality that becomes its own moral problem: where you are.
In a smaller hospitalâcapable, staffed, doing our bestâthere are moments when you cannot ethically pretend you are the right setting for what may come next. In those moments, your job becomes two simultaneous things: care for the patient in front of you and move the system fast enough to get her to a place that can hold the complexity if the worst happens.
So you pick up the phone. You call bigger hospitals. You initiate transfer. You try to make sure nothing catastrophic happens between leaving your doors and arriving at theirs, because the last thing anyone wants is a delivery in an ambulance. You do the peculiar dance of modern medicine where urgency is filtered through bureaucracy: long holds, vague answers, incomplete conversations, the sense that the person on the other end of the phone is emotionally absent from the reality you are trying to communicate.
đ± That night, I felt the surreal whiplash that I think every clinician knows but never gets used to.
On one line, Iâm discussing thresholds for resuscitationâwhat we can do, when it matters, when it doesnât, and why some interventions carry their own risks when used too early. On the other line, the world is texting about Christmas gifts. âWhat should we get him?â As if time is normal. As if the calendar protects us.
And in the middle of it all is a young woman who needs adults around herâpeople who know her, love her, can help her thinkâbecause decisions like these are difficult for anyone, and even more brutal when you are young, scared, and newly introduced to the fact that pregnancy can become a crisis without warning. I remember saying, in my own way, what I always try to say in those moments: take a few minutes. Call someone you trust. Let another brain hold this with you. Not because you need permission, but because you deserve support.
Here is where my household flu weekâsmall compared to what my patients faceâbecame a strange kind of teacher.
Because being sick while caring for my children reminded me how quickly caregiving drains reserves even in a home with partnership and stability. It reminded me how fragile âcopingâ is when sleep disappears. How thin the margin is between functioning and falling apart. It made me feel, in my body, what I already know intellectually: sustained caregiving pressure reorganizes a life. And if a temporary, ordinary childhood illness can shake a household to its foundations, then the long-term care needs that can follow periviable birth are not just âhard.â They are life-altering.
đ This is the part that makes my chest tighten when people talk about pregnancy and newborn life like the moral obligation ends at delivery.
We live in a culture that loves to demand outcomes it refuses to support. We argue fiercely about what pregnant women should do, what doctors must do, what babies deserve, as if obligation is simply a matter of insisting on intervention. But periviability exposes the deeper moral question: are we willing to build a world that can hold the consequences of that intervention?
Because if a child survives with profound needs, the burden doesnât land on legislators or commentators. It lands on a family. It lands on a mother. It lands on siblings whose lives get reorganized around crisis. It lands on the people least protected by our current systemsâpeople who may not have stable housing, stable childcare, stable transportation, stable insurance, stable work leave, or stable support.
So when I counsel families in this window, I am not only thinking about the next hour. I am thinking about ten years. Twenty years. I am thinking about what it costs to keep a fragile life alive in a society that routinely withdraws support from the disabled, the poor, and the caregiving labor that holds everyone up. I am thinking about the fact that âmiraclesâ are often sustained by invisible workâwork done mostly by women, quietly, without applause, without rest, without the infrastructure that would make that work humane.
đ And this is where gratitude shows up differently than it usually does on Christmas.
I am grateful my childrenâs illnesses, while miserable, were temporary. I am grateful my week of caretaking did not become my decade. I am grateful for the clarity that arrives when you are exhausted and your mind stops pretending love is simple. I am grateful for the colleagues who stand in these rooms and keep their humanity intact, who do not hide behind vagueness when patients deserve truth. I am grateful for the best version of medicineâthe version that is honest, compassionate, unflinching about tradeoffs, and unwilling to outsource moral weight to a patient who is already drowning.
And I am gratefulâstrangely, stubbornlyâfor the fact that I still care enough to be upset by how unfair this is. Because it would be easier, emotionally, to numb out. To call this âjust part of the job.â But there are moments in obstetrics that should disturb you. There are thresholds that should make you pause. There are situations where the systemâs failures are so loud that you can hear them in the spaces between phone calls.
Christmas, in my house, will be late this year. The kids will still get their magic; it just wonât arrive on schedule. That feels appropriate. Parenthood is mostly a repeated exercise in accepting that love and control rarely travel together.
But the thought I keep returning to is this: if we want to call ourselves a moral society, we have to stop treating peopleâs most difficult moments as private tragedies they should manage quietly. Periviability doesnât just test medical skill. It tests what kind of community we actually areâwhat we are willing to fund, support, and carry together, instead of insisting on outcomes and disappearing afterward.
So today, Iâm holding the messy kind of gratitude. The kind that doesnât perform cheer. The kind that sharpens responsibility. The kind that makes you see what youâve been spared, and what other people are being asked to endure.
Merry Christmas. đ
âYamicia D. Connor