• neonatology
• twins
• ethics

It is 04:00. The phone rings: the delivery room announces that 25-week preterm is about to be born from unstoppable caesarean labour; we will probably have to intubate him.

They do not have time to say anything else; I start running.

It is a recurring nightmare of a neonatologist’s nights, being alone to manage a preterm delivery. Imagine then that he is a 29-year-old resident who works in a neonatal intensive care unit, the place where he always wanted to be, and who is about to manage a problematic pregnancy of two little preterm twins, sons of a gynaecologist resident.

Imagine there is a father outside the delivery room. Immerse yourself in this father, who, on the other side of the receiver, with a heart beating and quivering with expectation, in the touching attempt to hold back the fleeting moment a little longer, wishes that everything goes well.

The dream fades, and the only audible sound is the low hum of the intensive care unit alarms, the place I love. It is the unconquerable temple and, at the same time, the arena where everyday silent battles are fought in the name of life, where the soul is broken down into thousand doubtful arabesques, where hesitation is not allowed.

The day I learnt that I would be a father, it was spring and there was a light breeze: my partner took me to the Molo Audace: literally the pier of the brave, also known as the pier of lovers. We were in the first act of a history that would rediscover us differently. We thought that if it was a girl, we would call her Isabella. Considering living in a country where births are falling sharply and will continue to decline due to the growing economic crisis and the uncertainty of the Bel Paese, where paediatricians complain about the lack of children but are worried about having one, we thought it would be an incredible adventure.

Then, we discovered that we would have two boys, that the pregnancy would be more difficult than expected, and that we would probably have to face equally complicated and premature labour. At night, I look at my gynaecologist colleague, who is resting peacefully. She faces the fear, or perhaps she hides it: for gynaecologists, the labour is still an iterative miracle, whatever the outcome, a long trip that ends with an unusual sweetness that you cannot get used to in an entire career. Instead, it is the beginning of an obstacle race for neonatologists in which muscles, brains and a cool head are needed. Furthermore, patience is crucial because all outstanding achievement is a little achievement for every premature newborn.

My partner can be sure I will be there beside her, before and after, that a neonatologist will watch over her babies. They are two male newborns, terribly too big and too turbulent to stay quiet until the end. Her father, a doctor, died at my age when she was just 10 months old, but she feels reassured that I, partner, father and grandfather together, know what her little ones can go through.

I smile. Like a proverbial reservoir of good mood,1 I also hide and joke about the struggles that the little ones, 24 weeks, are engaging in. I feverishly review in my mind the development of every organ, and I think that there is nothing equally selfish and unselfish at the same time of generating someone who is half the same as us, considering to dedicate the best time of your entire life to him/her.

At work, I smile, I simulate the theft of the rompers of the newborn if a mother snorts at the difficulty of changing a diaper to her baby, I propose a future exchange (with babies already born, of course), and at the same time, I hold my breath when my Chief explains all possible complications of premature labour. One by one, I imagine them multiplied by two, with the eyes too wide open of someone who only wants to live a linear life.

On the other hand, the assistance of a newborn releases you from the embarrassment of detecting the verbalised emotion that comes from an empathic contact but puts you in charge of taking care of it for both of you. You cannot touch a too premature newborn without his cortical tactile receptors turning your cares into pain, and the thalamus will filter your simple whispering that ‘everything will be fine’ if you are not his mother as secondary information.2 You have to accept that this is so and turn frustration into serenity. Becoming a father is part of a long process, made up of weakness and small steps forward, a bit like the path to become a doctor or like the development of a premature neonate.

So, in the place where doctors are afraid of being themselves the carriers of the infection for their little patients, I am reminded of an ancient passage handed down by Greeks’ and Latins’ wisdom, an arcane question that has never been answered in my dreams and reality: Γελοῖον γάϱ τόν γε φύλαϰα φύλαϰος δεῖσϑαι3; Quis custodiet ipsos custodes? Who will watch the watchers?

The phone rings. It is delivery birth room for the urgency of 05:00.

When this article is published, my sons will be in their mom’s arms or an incubator, before the eyes of their father. They could taste the smell of their mother’s milk, or they could generate energy from a parenteral nutrition. They could feel the touch of their grandmothers or they could feel the gloved hand of the nurse administering them the antibiotic course for a late-onset sepsis. Finally, they could sniff the first scents of the spring or just breathe oxygen from a ventilator. Both occurrences are the crossroads of an existence, which recurs every day together with the miracle of the life. I run to the delivery room, thinking that this job is the best and the worst job in the world. Quis custodiet ipsos custodes? I reflect about the dual meaning of this question. Who will guard our work, protecting doctors by their own mistakes? Who will take care of our bodies, and especially our fears?

The answer to each of you. Like twins, we are custodians and guardians of each other.