Up Close and Personal

On most weekdays at 7 a.m., Paul Miller is still in bed in his colonial-style house in Medina, Ohio, listening to his four children noisily prepare for school and thinking about his own day ahead at a nearby

investment firm. But on this overcast fall Thursday, Mr. Miller is sitting on a folding chair in the back of a dimly lit hospital conference room, privy to the kind of dialogue that could provide fodder for a medical thriller by Michael Crichton.

“It’s a nightmare considering you have four parents involved,” says one doctor from his seat at the U-shaped conference table, a modest spread of coffee and doughnuts behind him. “I told her 99.9-percent chance that the second fetus wouldn’t survive, but she wants 100 percent.”

On the wall to Mr. Miller’s right is a projection of a sonogram showing two fetuses, one healthy and the other not. A surrogate mother is carrying the twins for an adoptive mother who lives several states away. The adoptive mother wants one baby — a healthy one — but the surrogate mother isn’t sure she wants to terminate a fetus, even one missing kidneys and a bladder.

A second doctor, her arms resting on the table, says, “If there’s a woman with a baby in distress who doesn’t want a C-section, I can’t force her to have a C-section. Wanting a child who is perfect is borderline psychotic.”

The first doctor leans back in his chair. “That’s the business we’re in.”

Shadowing Doctors

This is the Akron Children’s Hospital’s monthly gathering of physicians to discuss the riskiest pregnancies they’ve seen in recent weeks. And Mr. Miller, a financial consultant at A.G. Edwards and Sons, is attending as part of a one-day event that gives local business executives, legislators, journalists, and other community leaders an insider’s view of the hospital.

Mr. Miller and 14 other participants in the annual event, known as Children’s Up-Close, will spend the day shadowing a doctor to whom they’ve been assigned. They will perform rounds, make home visits, and meet with patients’ families.

The Akron hospital’s fund-raising department developed the event six years ago, basing it on an idea promoted by the American Medical Association in the mid-1990s. The goal of the event, which has been adopted by at least seven other children’s hospitals, is to educate people about the challenges that doctors face and turn those people into advocates, donors, and supporters. In an average year, the hospital, which has a budget of about $300-million, receives approximately $11.5-million in contributions from private sources.

“Children’s Up-Close is really about relationship building,” says Angela M. Sass, director of major gifts. “We think of it as harnessing time, treasure, and talent.”

Increased Gifts

While fund raising is just one aspect of what the hospital’s staff members hope to accomplish through the program, they have plenty of anecdotal evidence to suggest that the event drives donations.

Eileen Burg, whose late husband was chief executive officer of FirstEnergy, a utility company in Akron, says she has given about $35,000 since she participated in 2006. Bill Cushwa, owner of the Braveheart Group, an investment company in Hudson, Ohio, created two funds of $25,000 each to benefit the hospital after he spent a day there in 2005. He contributes additional money each year.

A day spent at the hospital often makes donors more thoughtful and informed in their giving. Mr. Cushwa describes himself as a “big fan” of Sarah Friebert, the doctor he shadowed, and the funds he created specifically finance the hospital’s palliative-care program, which she directs. One fund provides gift cards that parents can spend at their discretion. The second enables Dr. Friebert to hire physical therapists, psychologists, and other professionals to help treat her patients.

Mr. Miller, who says he gives about $40,000 in charitable donations each year, has contributed approximately $1,000 to date to the Akron hospital through a holiday fund-raising event. But he began to learn more about the hospital through his neighbor, Norman Christopher, who serves as the director of pediatric emergency services. Mr. Miller says he was thrilled when Dr. Christopher broached the idea of participating in the Up-Close event.

Hospital staff members have made a few tweaks to the Up-Close event over the years. They’ve always held a dinner the evening before the event, so that participants have a chance to meet the doctors before being thrown into a hospital environment. Now they also ask someone who has participated in the program in the past to speak about what participants can expect from the day.

They’ve also extended the day by an hour, to 5 p.m., and pushed back a wrap-up meeting that gives participants a chance to share their experiences.

“Many participants have told us that Children’s Up-Close has been a life-changing experience for them,” says Ms. Sass.

One thing the hospital’s fund-raising staff members haven’t changed, however, is how little they intervene in the day’s activities. They organize the event, of course, and introduce doctors and mingle at meals. But they never ask participants directly for money, nor do they even discuss the hospital’s financial needs.

“I was floored by that,” says Mr. Miller, speaking several days after the program’s conclusion. “I have friends who asked me why the hospital was doing this, and I just said, they’re trying to make people in the business community aware of what the hospital does in hopes of getting them involved.”

Bleak Cases

By 8:20, Mr. Miller files out of the meeting with Anand Kantak, the doctor to whom he’s been assigned for the day. Mr. Miller peppers Dr. Kantak, a neonatologist, with questions. “What is ECMO?” he asks. Answer: a heart-lung machine. “How common are pregnancies involving surrogate mothers?” Answer: Increasingly common. Dr. Kantak says that women can make between $20,000 and $50,000 carrying a baby on behalf of another couple.

After a brief breakfast, the pair arrives at the neonatal intensive-care unit, where Mr. Miller will spend the remainder of his morning. About 50 babies, some as small as 320 grams, or less than a pound, lie under the glare of the unit’s lightbulbs.

Dr. Kantak, a small, energetic man who describes himself as a “C-Span junkie,” nearly as addicted to debating the economics of medical care as he is to diagnosing patients, walks among the babies, listening to reports on each one from his team of medical residents. Some of the stories the residents tell are hopeful: A baby girl has just been taken off a ventilator to breathe on her own, for example. Most of the stories, however, are heart-wrenchingly bleak.

One baby, born at 23 weeks, is at high risk of mental retardation or cerebral palsy, or both. Plush giraffes and bears adorn the wall above his incubator. The clinical terms that Dr. Kantak uses sometimes to describe the least-fortunate of the babies — “nonsurvivor” and “cusp of viability,” for example — fail to reduce the emotional wallop of their stories.

Nearby is a tiny, blond boy, lying on his left side under a mobile decorated with Ohio State University Buckeye football players.

He was born with a heart defect, and until a few days ago was too small to qualify for the surgery that just might save him. Dr. Kantak has a meeting scheduled in the afternoon with the baby’s parents, and he plans to tell them that a cardiac surgeon in Michigan has agreed to consider the child for surgery.

Even then, however, the baby’s chances for survival are minuscule.

The surgeon could decide upon seeing the boy that performing surgery is simply too difficult, says Dr. Kantak. What’s more, the surgeon has performed fewer than 10 operations of this type.

“It just makes you realize how blessed you are to have healthy children,” says Mr. Miller.

Talking to Parents

After lunch, Mr. Miller and Dr. Kantak return to the neonatal intensive-care unit, where they will meet with the parents of the baby born with a heart defect.

Mr. Miller says he has reservations about attending the meeting. “I can’t imagine they would want me there,” he says.

But when the two arrive in the room, Mr. Miller finds that a nurse, a medical resident, and several other hospital staff members are present as well. He takes a seat to the right of the door, while the parents sit on a sofa at the back of the narrow, windowless room.

Dr. Kantak, who sits in a rocking chair closest to the parents, begins by asking them how much they know about their child’s condition.

“This is no one’s fault,” he says to the mother. “It’s not your fault. It’s not his fault. This is nature’s error.”

A few minutes into their conversation, Philip Smith, a cardiac surgeon, arrives. Dressed in bright blue scrubs, he speaks candidly about the slim chances of the baby’s survival.

“It’s important for you to ask, Is this being done for my baby, or to my baby,” he says. “If you ever feel that something is being done to your baby, you should speak up.”

A few minutes after the meeting concludes, Mr. Miller is standing by the doors of the intensive-care unit when the parents walk by. He offers them a few words of sympathy. (The baby died soon after, while still being evaluated for surgery.)

‘Reality Check’

By 4 p.m., everyone gathers in the conference room. Dr. Christopher, the hospital’s burly, silver-haired director of pediatric emergency services, opens the meeting by providing a doctor’s perspective on the program. “When you do this every day, you need a reality check,” he says. “Having someone to ask questions can be an awakening.”

Then a few of the participants speak up. Vicki Karabinus, the president of InFocus Small Business Strategies, in Medina, describes an unnerving situation she witnessed in the emergency room earlier that day.

A mother checked her teenage son into the hospital out of fear he would commit suicide, Ms. Karabinus says. But the boy’s father, who has legal custody, was furious and tried to get his son released. It took a few hours before security personnel were able to calm him down.

“It was a tough spot,” Dr. Christopher deadpans.

Mr. Miller also speaks up. He describes the meeting he sat in on earlier that afternoon, saying what a great job the doctors did in communicating to the parents just what options were left for their son.

Dr. Smith plays down the importance of the conversation, saying that he and Dr. Kantak spent two months preparing the parents for that talk.

“But you did a great job delivering really bad news, even if it wasn’t new news,” says Mr. Miller. “I used to think my job was high stress, but compared to what you do, it’s nothing.”

Helping Out

Reached by phone after the event, Mr. Miller ticks off the things that impressed him most about the hospital. There was Dr. Smith’s gentle way of delivering news to the baby boy’s parents, for example, and Dr. Kantak’s patient encouragement of his resident physicians.

He also discusses his plans to become more involved with the hospital. He and his wife are considering a donation of $10,000 before the end of the year, Mr. Miller says.

He also hopes to volunteer at the hospital, perhaps by educating donors about the tax incentives available for different types of charitable gifts.

“I like helping people with financial issues,” he says. “That’s my talent, my way of helping.”