Episode 37: Pursuing Good Enough with NICU doc Dr. Susan Landers

🎶 Podcast Intro: Welcome to the pursuing uncomfortable podcast, where we give you the encouragement you need to lean into the uncomfortable stuff life puts in front of you, so you can love your life. If you are ready to overcome all the yuck that keeps you up at night, you're in the right place. I am your host, Melissa Ebken let's get going. 🎶

🎶 Episode Intro: Hello, Hello! Welcome back to the Pursuing Uncomfortable Podcast. I'm Melissa. Today. I have a real treat for you. I have with me, Dr. Susan Landers. She is a retired NICU doctor and she has story after story, after story to share with you. She's going to share a couple of those and what it was like to be on the other side of that situation in the NICU. She also has a lot of other experiences and a book to share. So I can't wait to introduce you to Dr. Susan Landers. But before we do that, I want to remind you to leave a comment, post a question, let us know what you think of the podcast, what you'd like more of over on melissaebken.com/blog. Also, check out the video version of the podcast on YouTube. Search up, Melissa Ebken and you'll find it there. 🎶

Episode
Melissa Ebken  0:24  
Hello, Dr. Susan, welcome to the Pursuing Uncomfortable Podcast. How are you today?

Susan Landers  0:36  
I'm doing great Melissa thanks so much for inviting me.

Melissa Ebken  0:40  
I'm so glad you accepted the invitation. And I know you have a lot going on. As we were discussing earlier, you're getting decisions made on your house getting rebuilt after a fire in November. Glad to hear that process is going along. Well, and I'm glad you have the chance to to speak to us today.

Susan Landers  1:02  
Well, it's my pleasure. 

Melissa Ebken  1:04  
So Doc. How should I refer to you? Do you like to be called Dr.? Dr. Susan? Dr. Landers?

Susan Landers  1:11  
Susan is good. I used to go by Dr. Landers when I was practicing. But since I've retired, I think that's too formal.

Melissa Ebken  1:19  
All right, Susan, it is. And if you change your mind, throughout the interview, just let me know. Susan, and I've been with parents who have had children, babies in the NICU. And I've not seen that kind of stress as a parent. And I know that there's no other stress like that, as a parent, to have your baby fighting for their life. But you see that from a different perspective. What's it like to be the doctor fighting for life for these babies?

Susan Landers  1:58  
I think it's one of the most wonderful careers imaginable. It is medicine, at its very best. And medicine sometimes at its rawest and most tender. Because in the critical care unit, we take care of sick, newborn babies or extremely premature babies. Not all of them survive. Some of them have devastating diseases and the process that we go through to provide work treatment, and emotional support the family sometimes doesn't work, those moments are horrible; not only for the families, but also nursing staff, respiratory therapists and doctors. ICU care is a challenge. Lots of people avoid it because it is so critical and its moment to moment. And there are resuscitations and there are intubations. And ventilators are used and drips are used and things can go south quickly. And that's what draws most of us to the ICU. Because it is critical care. It's on the cutting edge. All the new technologies are there, all the new medications, but for me, it was more than just critical care. It was Mother's babies. And I think that working in a place where I can get to know a family sometimes be at the delivery. Whether it's a single baby or a set of twins or triplets, be at the delivery and then care for them for weeks or months until they go home. Get to know the family. Be with them through all the ups and downs at the bedside, explaining things, holding their hands and then finally releasing the little darling to go home with their parents. It was just the most amazing, intimate wonderful to leave it. Sure there were moments of sadness. Sure there were times when I felt defeated, couldn't save a baby. And that's, sure there were some complications. Some of the tiniest premies will have severe hemorrhages into their brain, chronic lung disease and stay in the hospital from months. Melissa I enjoyed being a cheerleader for breastfeeding. NICU moms would commonly have to pump to express their breast milk. And this might go on for weeks and weeks until the baby was actually able to be put to the breast. And I felt good about being a cheerleader for something that was so good for mom to do to contribute to her baby's care. It was wonderful, and they loved it. Moms and dads both would hold their babies skin to skin at the bedside. And they loved that as well. And the babies responded with less breathing pauses and better weight gain. So I got to do things that were very pediatrician-like, supporting bonding, supporting breastfeeding, talking with moms about issues going on with their older toddlers or children. Moms would say to me, Oh, you must have perfect children, because here you are, an ICU doctor and a pediatrician, I would go Oh, no, I do not have perfect children. Let me tell you some stories. And we would compare stories and tell each other about our trials at the bedside. Now, of course, you don't do that when a baby is critically ill hanging on by their fingernails. You only talk to the parents about the medical situation, the therapy, the treatment, how the baby is responding. But after those initial shock, people do have a lot of questions. And I like to take the time to answer those questions. I always encourage parents to write things down. Sometimes what doctors say to people goes in one ear and out the other. And so I liked it when they would write questions down and bring them in or take notes during case discussion. The best thing though about working in the NICU was being part of the family and being a major part of the health care team that took care of their baby. And it was very much a team effort. Lots of NICU nurses come and go. Working various shifts during the week. Respiratory Therapists are there, Lactation Consultants, Social Workers, Case Managers, Physical Therapists, it took a whole team. And the one thing that I have missed the most Melissa since I retired, is teamwork. I enjoyed being part of a hospital based team that worked together. We knew each other's strengths. We took care of things, and we made a big difference. So that was wonderful.

Melissa Ebken  7:53  
That's a powerful statement. I am I'm going to attend a wedding in a couple of months from this recording of a young woman who was a NICU baby, oh, so many years ago. She had a condition and I don't recall the name of it. She had one kidney, her intestines were turned. She didn't have an esophagus, they had to build an esophagus. And there was some kind of revolutionary treatments with her blood. And the blood starts with an H the the hemo something hemoglobin that, I guess is really common now, that was just a revolutionary kind of a testing sort of situation then. So as a doctor and as a team member, how does the team decide when to employ a new strategy?

Susan Landers  8:55  
Well, we keep up with new treatments, new medications, new ventilators, new methods of supporting babies on ventilators at our medical meeting, and our scientific research meetings present data that usually done in randomized controlled clinical trial, preferably in multi centers. And so we hear about the newest therapy in the medical meeting, and that or we read about them in papers that are published. And then we bring them to our practices. And we discuss as a group of physicians how we're going to use a new therapy or a new ventilator. A great example with artificial surfactant a long time ago in neonatology, babies were born with respiratory distress syndrome and would struggle to breathe and struggle to live. And we did not have anything but oxygen and mechanical ventilation to take care of them. A lot of them died. We developed artificial surfactant, the drug companies developed it. And clinical trials were undertaken. And 1,000s and 1,000s of babies were in these trials and we proved how to use it, what dose to use, what's safe, were their side effects. And then that technology now is standard care in the NICU. So we don't adopt medications or therapies lightly. We, sometimes parents come in and have they found something on the internet and they'll say, oh, Doctor X says we should use Y to treat our baby. And Y may be something that's never been tested, never been tried. Certainly not in a controlled trial. And the parents don't understand that. And so neonatology is very much controlled, trial driven, research driven, because it is so technical. So those new therapies are always discussed, the doctors lead the discussion a nurse may ask questions. Someone from another unit may come into your unit and say, well, we tried this over here. What do you think about that? And so human beings being what they are, they're always curious, and they always want to talk about alternatives. And so an open dialogue between team members, an open dialogue between the parents, what they're reading what they're hearing, and what's actually going on, is always part of ICU care, even in the NICU, probably for grown ups too.

Melissa Ebken  12:00  
Well, and as the one who has to make that call, or who had to make that call. What was it like for you in those moments to make a difficult call?

Susan Landers  12:12  
Well, I think over the years, you get more skilled at figuring out what the parents think, figuring out what the parents want, what their dream for their baby is. Learning how to talk to people in an honest and factual way. But also be compassionate, making difficult call is really providing families with adequate information to give their concurrence with a medical call. For example, if I said, a baby had a certain complication, and we wanted to try something new to treat it, I would tell them, here's what we know, here's what we don't know. We could hang back and do nothing and wait and see or we could try this new therapy. And so the parents would have a say so, always. Nowadays in the NICU parents have a say so, and I felt like more of a guide than a decider. I mean, surely, of course, in an emergency situation, I decide. The doctor decides, the nurse decides, the therapy is urgent. But there are lots and lots of situations where parents and physicians and nurses sit down and make a decisions together. For example, a baby who has a lethal birth defect, if a baby is born with a severe heart defect, or a brain defect, or bowel or kidney defect, as you just alluded to, and none of those can be surgically repaired, but the baby is on a ventilator, it's appropriate to sit with family, talk about what's available, what's possible, what's not. And if things are impossible, and care is futile, it's appropriate to remove the baby from mechanical ventilation and allow the baby to die of their congenital birth defects. Those kinds of situations do exist. And parents appreciate being given the information they need and the time that they need to come to terms with what's the best thing for their baby.

Melissa Ebken  14:43  
So Susan, how would you leave the hospital at the end of the day and go home to your family and leave all of this behind as best as you could?

Susan Landers  14:54  
That's a very good question. Sometimes I took it home with me, sometimes talking with my associates or the nurses in the hospital allowed me enough of a decompression and not bring it home. I was very fortunate to be married to another pediatrician. My husband is a pediatric nephrologist. And we would sit at the end of the day at the dinner table, and we would kind of unload on each other the good and bad parts of our day. We we raised three children while we were both practicing full time, and my youngest told me just within the last year, Mom, you know, we used to have to wait for you and dad to say everything you needed to say before we could talk about our day. And I went, oh, my God really wasn't that bad? And she said, Well, pretty much you and dad had to had to sort of tell each other what happened. That was only worst case scenarios. Frustrating things. Aggravating things. Sometimes working in a hospital system doesn't go just lickety split. And, and we would complain to each other about things like that. But we also practiced family dinner time and everybody in our family got to talk about their day and what went good and what went bad with their day. So the answer to your question is, I did not always leave it at work. I brought a lot home with me. And there were various periods in my career, when I was more temperamental, or more moody, or even sad, if a baby who was doing very poorly, was not getting better. And the family knew it. And I knew it. It made me sad. And it made them sad, because we knew we were losing the baby. And so there were some things that you couldn't just throw away. I mean, you it just, it stays with you. So I think that physicians deal with those issues, those stresses of their work in different ways. And it depends on the kind of patient the physician takes care of. It depends on the family, in my case, mother and dad around the baby, sometimes grandparents too. And it depends on your communication with the family, and their understanding of the situation that affects all of that stress level. If you for example, if I had a family who disagreed with a recommended therapy, say two or three physicians in my group thought we should do this. And the family said no, we don't want that we think you should do this. That's a pot problem. That's a conflict. And and those cases are tricky. And those cases would take more effort and more stress to work through.

Melissa Ebken  18:06  
So how did you decide it was time to move on from the NICU?

Susan Landers  18:13  
I'll tell you I loved working in the NICU for 32 years. Wow. I found myself at age 60, being burnt out. And it wasn't abrupt, it was a slow slide downhill, over a couple of years. I had been working 50 hours a week, still taking night calls at age 60. A lot of complicated ethical cases were going on at the time, a lot of parent/physician conflict. And I started dreading going to work, which was unusual. I never felt that way. I was unable to sleep, I was in a bad mood. I kind of kept away from my colleagues. If I was on call and all the work was done, I would go hide out in my call room and kind of hide and avoid interaction, which I always loved. I loved talking to parents and talking to the nurses. And so I noticed that my behavior was different. And then one of my friends made a comment to me about a particular case and he said you're not acting like yourself. And that's when I knew that I had lost some of my ability to be compassionate. I had become grouchy and impatient and intolerant and very cynical. That was burnout. That's how physicians feel when they're burned out. And so I recognized that and my practice gave me an opportunity to go to work part time in a low risk. labor and delivery unit. Level two or normal moms and babies. And nobody else wanted to go there. And I said, Oh, I'd love to do that right now. That's just what I need. And so I went to this new unit, and I supervised the nursery. I attended deliveries. I talked to normal moms and normal about normal babies. And it was so wonderful, you know, with breastfeeding and grandparents visiting and balloons and siblings that it was the whole wonderful experience. There were very, very few sick babies. And I remembered how much I loved babies and loved working with mothers and babies. And so I slowly, in that different practice setting, working fewer hours, with way less stress, I slowly recovered from my burnout. The other things that I did during that time, I took piano lessons, which helped a lot, that music carried me away somewhere else. I did some needlework, some counted cross stitch, which I find to be very meditative. And I had stopped doing that. And I also thought psychotherapy, I thought that some of the issues that I had accrued over the previous 30 years were so furious, that I wanted to work through those with a professional therapist. And she helped me quite a bit to pinpoint the things that had sort of tipped me over the edge. In all honesty, the majority of my burnout was from working too many hours, and not getting enough sleep. And I don't think patients and parents always understand that some physicians have practices in which they really are pushed physically. And then they will be pushed mentally. So I let myself work too much. I let myself work too hard. And that led to my being burned out. So as I recovered from my burnout over a two year period, then I decided I was ready to retire. And I've had no regrets. Since retirement, it's been a welcome relief.

Melissa Ebken  22:30  
Well and all of these experiences inspired you to write a book.

Susan Landers  22:36  
Yes, yes. The girlfriends in my book club would say, one of them said, You got to write a memoir. I would keep telling stories from the NICU. And this mom did this. And you know and never revealing any medical information, but telling interesting stories. And they would say you've got to write a book about all these NICU stories. So I started jotting down stories from of the most special patients and parents. Parents who had inspired me or parents who are particularly courageous. And I let a couple of my friends read that and they said, Well, this is great. Why don't you tell your own story? As a mom as a working mom, as a working physician? I said, okay, so went back and I have woven together the two stories, the NICU babies and parents that are very typical of being in the NICU and my stories with my three kids that I think are very typical of working mom. And that's what the book is about. And the name of my book is So Many Babies. And it tell about my constant struggle to balance a busy medical career with being a mother.

Melissa Ebken  23:58  
What do you say to the mom who is completely stressed out, raising her kids right now?

Susan Landers  24:05  
Oh, wow. I am so concerned about working moms right now who are stressed out raising their kids. They are doing what I did in my 30s and 40s. They are trying to do everything perfectly. They're trying to do everything on their list. They're trying to be the best mother they can be. They've been beaten down by the pandemic. They've been beaten down by remote work, home schooling, remote schooling, their children, lack of childcare and maybe a husband or a partner who doesn't help very much. Studies, I think survey show that for every five hours women work in the home with household or childcare duty, the husband does one. So the working mothers are doing what I used to do, and that is everything. And that can't be done. It took me a while in my 40s to get to the place where I would write a list of all my priorities and all the things the kids were into and all the things I wanted to do. And I actually was in therapy at that time too. My therapist would say, Well, isn't there something missing from this list? I said, Yeah, me, I'm the one missing from the list. I wasn't doing anything to take care of me. I was taking care of them and my husband and my job and school teachers and coaches and the whole ball of wax. And I think what working mothers are doing right now is they're taking care of everything, without figuring out how to take care of themselves. That's just my take on what's going on. And I've talked to a lot of millennial moms that I see in my Pilates classes and exercise classes. And they tell me, that's what they're doing. They're doing too much. They're trying to do everything and trying to juggle it. And they come up feeling short, and I go, Well, you there's no way you can do all that. I mean, come on. You can't do that. Why don't you do three fourths of that? Wow, I never thought about that? It's not that easy. But it is. It is basically women who are working and trying to raise children, are doing more than is humanly capable. That's my belief.

Melissa Ebken  26:32  
I'm sure there are a lot of people that would agree with you on that one. Susan, the link to your book is in the show notes. So just hop on over there, folks, click the link, buy this book, you'll be so glad you did. Susan has such an amazing story, so many amazing stories to go along with so many babies and such great wisdom. Because she's been there. She's experienced that. Her family moved, she's been unhappy in places, there's so much more to her story. I encourage you to buy the book. Susan, do you have any parting words for folks today?

Susan Landers  27:13  
Well, thank you for asking, I want working moms, to know that what they're doing is difficult, and to give themselves a break, and to give themselves a little grace, a little time to breathe, and maybe meditate and maybe talk to a friend. I want to give working mothers permission to take care of themselves. And I admit that I made that mistake early on and didn't do that. And I learned the hard way that the only way you can survive, having a full time job and a full time family is to take care of yourself. So that's my advice for working moms.

Melissa Ebken  27:55  
And you've also provided a checklist to help us do that. 

Susan Landers  27:58  
Oh, yes, I have a checklist on my website. It's called Checklists For Burnout and Overstressed Working Moms. And if you go to Susanlandersmd.com/BURNOUT. Burnout is in CAPS. You will get a free checklist. And I also have on my website, a guide for solutions, if you are burned out. So

Melissa Ebken  28:28  
That link is in the show notes. So if you didn't catch it, hop into the show notes in the description and the link is right there.

Susan Landers  28:37  
Right, 

Melissa Ebken  28:37  
Susan, I could talk to you for days. I would love to hear every story about every baby. But I'm afraid that's all the time we have for today. So thank you so much for sharing your wisdom with us and some of your stories. 

Susan Landers  28:53  
Oh Thanks, Melissa. It's my pleasure and my privilege and I'm so glad that that you invited me and I'm so glad that you have lots of working moms listening so maybe they'll get a little piece of sensibility.

Melissa Ebken  29:07  
I hope so, because we can all use it. Yeah, be well, Susan.

Susan Landers  29:14  
Thank you. You too.

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