Q&A with the Scholars: Experiences as a Pediatric Critical Care Physician

Monique Robles, M.D., M.S. is a board-certified pediatric critical care physician. In this interview she discusses her experience treating critically ill children, offers encouragement to parents of ill children, and discusses why she is pro-life.

Monique Robles, M.D., M.S.

As a pediatric critical care physician, you have experience treating children with a range of life-threatening conditions and severe disabilities. What would you say to a woman who is considering having an abortion based on a prenatal diagnosis?

Being trained in pediatric critical care medicine affords me the unique perspective of evaluating and caring for acutely ill, otherwise healthy, children and for children who have chronic medical illnesses related to genetic disorders, neuromuscular disease, anatomic malformations, traumatic brain injuries, and/or compromised immune systems (to name a few). Taking care of the latter – oftentimes the same child on numerous occasions – is accompanied by much mental anguish, emotional turmoil, and physical exhaustion for the child, the parents or guardians, and the healthcare professionals. If the diagnosis were known prenatally, then one might be led to think . . . “save the parent and the child from such suffering.” Yet, all of this agony is only a flickering flame next to the fire of love that burns for these children.

Knowing what to say to a woman considering an abortion based on a prenatal diagnosis must be composed after listening to her fear, anxiety, and unique circumstances. Simply listening begins to dismantle any barrier that may interfere with her choosing life. Then, given my uncompromising belief that all life is sacred, I would encourage her with my own personal experience of growing up with two siblings with Down Syndrome, as well as my professional encounters in taking care of so many chronically ill children and their families. Sharing true stories and offering her the option of connecting with other families who may have a child with the same or similar diagnosis could be a life changer, not only for her but for her child, as well.

A woman must not feel alone. She and her child must not be abandoned. Choosing life does not guarantee the absence of hardships but is always the most loving and giving decision.

How has working with critically ill children shaped your view of the medical profession and the human person?

I can recall the words of one of my attendings when I began my fellowship in pediatric critical care: “This (experience) will change you.” And, I thought, “no.” I saw myself as a loving, compassionate individual, who would continue to care for children. But, he was correct. I did continue to care for children as if they were my own, but with a growing humility and a realization that I am not the final say in whether or not a child lives. When children are delivered from the snares of death and walk out of the hospital, I rejoice in the save. When children die in the rooms in which we care for them, I often lack wisdom and understanding. I realize I am only an instrument in greater hands than my own.

I see things in a different light. What may be the common cold for many people could result in respiratory failure and implementation of mechanical ventilation for a child. My mind has been trained to see and hear the finest of details and my bedside intuition has been sharpened by experience. I often take for granted this call to the medical profession, in which my work really matters in the delicate nature of human life.

What do you see as the biggest challenges facing pediatric critical care physicians today?

One of the biggest challenges I see is keeping the dignity of the child at the forefront of all decision-making in light of growing technological and surgical advances and pharmaceutical options. The existence of a newer therapy does not justify its use in all situations that it may be intended. What may be proportionate for one child may be disproportionate for another given the circumstances of the child.

There must be a reasonable expectation in improvement or restoration of the child’s life, not merely a relentless use of artificial means in cases where death is imminent, stripping the dignity from the child and prolonging his suffering. It is okay to say, “we have offered all we have to give and all we can do.” Therein lies another great challenge – being able to admit our limitations and then having the courage to continue to accompany the child and the family in the final stages of life and not abandon them.

Do you have any words of encouragement for parents of critically ill children?

Words of encouragement are difficult to find in times when stress obscures any rational thought. Once the initial conversation has taken place, I encourage the parents to take care of themselves – hydration, nutrition, sleep – in order to be at their best for their children. I think it is important that they are given the opportunity to contribute to the daily plan and the bedside care of the child, as much as is feasible, so that they do not feel powerless.

As for words of wisdom for those parents who I foresee will be within the walls of the pediatric ICU for a while, given the scope of their child’s illness, I have two words to offer – time and patience. It is important to be cognizant of the necessity of time in order for physical healing to take place and for providers to work through complicated illnesses, searching for diagnostic and therapeutic answers. Time, though, is very difficult to process in the ICU – days and nights are blurred by the constant alarms that interrupt any chance of sleep and the frequent necessary nursing assessments to alert physicians of any change in status.

Patience, because we, as physicians, may not have an answer right away for the etiology and the extent of their child’s illness. In these situations, most especially, communication is vital. When I explain the findings and the plan with the family, allowing them time to process and ask questions, a bond of trust is strengthened; and we work together in caring for their child.

Why are you pro-life? If you had 60 seconds to explain to someone why you have pursued the work that you have throughout your career, what would you tell them?

I am pro-life because I have been given the very free gift of life. A true physician is pro-life. Our very profession and nature are to heal and bring about restoration . . . not to destroy, mutilate, cause suffering, or kill. Any attack on life, even if perceived under the guise of compassion, remains an attack. Jesus, the Divine Healer, cured, restored, and brought to life those who had died. I am pro-life because I am an instrument in those Divine Hands. The only way my notes can be melodic is if I am in tune with the very Hands in which I am held accountable. The resilience of children gives me hope. When I care for another’s child, I do so as if the child were my own.

Dr. Robles’ full biography can be found here.