Waffle Friday in our unit, peri-pandemic
How many of us dread telling people what we do for a living? I’m not always eager to admit to being a neonatologist. For one thing, that’s a hard word to say. For another, it usually has to be explained further (not a nephrologist: that’s a kidney doctor. Not a neurologist: that’s a doctor who deals with nerves and brains. A neonatologist is a “newborn intensivist,” a pediatrician who specializes in critical care for newborns.) And then, finally, the response is often some variation of “oh, you’re a superhero!”
One reason this bothers me is because I am all too aware of limits, both of my own individual abilities and of available medical interventions. The same things that fascinate me about my specialty and daily work — the challenges of supporting a baby’s transition to ex utero life, growth, and development when she is born too early, when that transition isn’t smooth, or development has gone awry somehow, or all of the above — can also be daunting. For example, a baby who is born at 22-24 weeks has especially complex and interrelated problems with immaturity of multiple organ systems. The term we use in this age range is “periviable,” meaning around this time the likelihood of survival outside the womb is precarious at best, even with all-out high-tech care. The lungs are markedly underdeveloped, yes, but so is the skin, the kidneys, the immune system, the gut, the cardiovascular system. And the brain. So it’s possible to “do everything” we can for a periviable premie — which is a lot! — but, in the end, we can’t “fix everything”. Nor can we fix every problem that comes from abnormal development of various organ systems, even with amazing pediatric surgeons and other subspecialists on our team.
And “team” is a key part of newborn intensive care, because there’s no way one person or one job description can take care of all the needs of sick babies and their families. In addition to other medical and surgical subspecialties, we need nurse practitioners and physician assistants, nurses, respiratory therapists, dietitians, pharmacists, lactation consultants, physical therapists, speech therapists, occupational therapists, social workers, and case managers. We need the unit secretaries and the techs and the housekeeping staff. In our teaching hospital, we definitely need our trainee physicians - students, residents, and fellows - to keep asking questions and helping us learn. People talk about the “hive mind” in the NICU, the way care teams talk amongst ourselves about challenges in managing patients and sort through possible solutions. I would suggest we also have a “hive heart” — an emotional connection that lets us care for each other so that we can care for the babies and their families.
All of the above lies beneath my aversion to the “superhero” characterization. Growing as a neonatologist has helped me grow as a human being, and being labeled a “superhero” touches on misconceptions I’ve been forced to confront: expectations of being smart enough to figure things out, of having instant fixes and easy answers — in short, of perfectionism. Watching babies grow and develop on their own time has helped me realize that even adults are still growing and developing, and that we all need patience with ourselves and one another. Working in a team setting has helped me value connection to others and see my need for community.
Pondering the current pandemic and our sociocultural (and political) responses has brought this all home for me. Of course we want “superheroes” to fix things - but none of us has that ability. (Dr Lorna Breen’s suicide was a sobering reminder of the danger in our profession’s accepting and internalizing that expectation.) There are no quick solutions. None of us can know everything, do everything, fix everything. We are all fallen, broken, limited - but it’s still possible for each of us to acknowledge our individual limits and to listen to each other, encourage each other, and work with each other. We can’t do everything, but we can do all we can. And we must.
Our NICU had a “waffle Friday” back in early spring, when the pandemic was just getting started and those healthcare-worker-as-superhero memes were all over the internet. (Side note: the “waffle Fridays” are just one example of our unit’s “hive heart!”) Anyway, I was amused by the napkin I ended up with, so I took a picture to remember. As I drove home that day, I pondered again: “if you could ask for any superpower, what would it be?”
And suddenly the answer came to mind: “it would be love.”