"I was placed for adoption by my teenage birth parents during a time when closed adoptions were still commonplace. Each year on my adoption day, my adoptive mother would tell me the story of how I came into their lives. The story grew in detail as I aged and was interrupted by more questions. I learned that I was briefly in foster care during a state-mandated waiting period before the termination of my birth parents’ rights. Because my birth parents wanted my adoptive parents to have the opportunity to name me, I was unnamed while in foster care.

I am compulsively curious. I always knew I would search for my birth parents, which I was legally allowed to do after turning 18 years old. In my home state, you needed to provide a valid reason for searching along with a notarized petition requesting court approval to open the sealed adoption files. Through my own research, I learned that it was possible to request nonidentifying information before petitioning the court. I requested this information soon after turning 19.

The documents I received were photocopies with identifying information carefully cut out from the pages. It was strange to hold pages of information about me with small rectangles of variable sizes missing in a seemingly random fashion. In many ways, it reflected how I felt about those early weeks of my life; there were small and important missing pieces. I was most struck by my original birth certificate, which I had never seen. The name field simply read, “Baby Girl.” For the first 6 weeks of my life, my name was Baby Girl.

Soon after my 20th birthday, I met my birth parents. My birth father expressed guilt for never having held me. He explained that the hospital staff offered to let him hold me shortly after I was born and that he felt it would be too hard to see me and then give me away. He confessed that he had been carrying that guilt for my entire life. When I met my birth mother a week later, she repeated this familiar refrain. She remained in the hospital recovering for several days after I was born. She said that the hospital staff kept offering to let her hold me, but it was too emotionally painful, an offer she repeatedly refused.

Until that moment, I never had a reason to imagine those first few weeks. Now my mind wove a story of an unnamed newborn that no one wanted to see, alone in a hospital room, unloved and never held. I did not know how to challenge that narrative, so I carried it with me.

During my third year of medical school, I met another Baby Girl. I was assigned to follow her during my inpatient pediatrics rotation. Her birth mother was choosing adoption and was not present with her in the hospital, something I understood from conversations with my birth mother over the years.The narrative I created about my time in the hospital as an infant did not play out as I imagined with this baby girl. I cuddled her every morning when prerounding, but I wasn’t the only one. Everyone on the team loved and cuddled Baby Girl. The pediatrics team took turns holding and feeding her as did the nursing staff. She spent so little time alone in her hospital room that the nursing staff learned to look for her in the medical team room. She may not have had her birth parents at bedside, but she had an entire unit’s worth of staff showering her with love and affection.I reflected on the narrative I created when I learned that my birth parents had not held me. The narrative never included the hospital staff who were taking care of me while I waited for foster care placement. Taking care of Baby Girl allowed me to imagine a new story for myself and revise the narrative.I asked permission to draft her discharge summary. There is a section in our template labeled “Other.” I filled this section detailing how much she was loved and cuddled by everyone on the care team. I wrote about how much attention she was given and how little time she spent alone. I don’t know if she will ever see the discharge summary from her very first hospitalization. If she does, I hope that it will help her to fill in some missing pieces and know that she was loved from the moment she came into the world.

During my pediatrics rotation, I learned the importance of documentation in the medical record for billing and medicolegal reasons. Attendings and residents frequently discussed what needed to be documented and how it needed to be described. I also learned that the medical record can be used to communicate love. I hope to continue to use the medical record in precisely this way for the rest of my career. I hope that other clinicians might consider documenting love as well. A few words may have the power to change a lonely and long-held narrative. Everyone deserves to know they are loved."

JAMA • Baby Girl

JAMA • Baby Girl