For as long as I have been a pediatric resident, I have been a self-proclaimed inpatient medicine person. There are some people who thrive in clinic – I am not one of them. I am one of those rare pediatric residents who has found my calling in the Neonatal Intensive Care Unit (NICU) amongst the tiniest of babies, ventilators, and fractions of ounces. I love the acuity that comes with the NICU, but also the dichotomy of the continuity that it can provide when patients often stay on the unit for weeks to months. Like the outpatient clinic, you can connect with families quite intimately over the course of a NICU hospitalization.
While rotating at our community hospital’s NICU, I had the opportunity to care for a family that changed how I plan to practice as a clinician. This infant was a long way from discharge in that they were very premature, but stable enough that the acute interventions were mostly behind him. In the first week that I cared for him, I never saw anyone from his family at the bedside. I would call to give updates. The few times I was able to get ahold of the mother, she would thank me and rarely had any questions. She would give vague answers when I asked if she knew when she would be in next so I could be sure to introduce myself in person. On rounds there would be occasional eye rolls or intonated comments by some team members when discussing if anyone from the family had been to the bedside. The family absence started to be interpreted as the family lacking in qualities you hope for in parents – love, responsibility, and consistency.
One afternoon in my second week, I had the time and space to get some extra tasks done – the perks of working in a lower acuity NICU. For this particular NICU, there is a grant in place so that a trained social worker is on staff to screen moms for signs of post-partum depression and then connect them to resources if needed. The social worker had been out for vacation and this infant was now 8 weeks old, so the mother was due for her second screening. I called the mother and went through the depression screener with her. What I learned during this conversation was that this mom was suffering from severe post-partum depression because within a week of going into preterm labor, her father-in-law had passed away. She was struggling with an insurmountable guilt that she was the cause of his death because her mother-in-law had been so focused on tending to her after the delivery. She felt that if she hadn’t delivered early, her mother-in-law would have been more focused on the health of her father-in-law. The patient’s father was grieving and trying to coordinate his father’s funeral. Moreover, they had two other young children at home. She cried to me about how terrible she felt about not being able to come to the hospital more frequently but had no one to care for the other two children while she visited.
After sharing what I had learned with the rest of the infant’s care team, there was a complete shift in tone towards the family – one of more compassion and empathy. We were able to connect the family with community resources and counseling. Nurses bent over backwards to make virtual visits with the family and infant possible.
My experience with this family made me hyperaware of an area that the NICU can improve for families. In that peripartum period when the ICU team is so focused on the medical outcomes of the infant, the family support system often gets neglected. This is something that we do so well in the world of outpatient clinic. One of my favorite aspects for those newborn visits is making sure that the parents feel well supported and get connected to the resources that they need to best take care of their babies. Moving forward, as a future neonatologist and leader of a clinical team, I have learned that it is so important for both my team and I to not make judgements about a family’s participation in their child’s care without asking more questions and trying to better understand a family’s situation outside the hospital. In my future career as a neonatologist, it is my goal to never lose track of those family-centered skills that I learned in the outpatient clinic.