Becoming an Astronaut in the NICU

I have always loved outer space. Like some others in medicine, I started off as a science geek absolutely fascinated by the world around me, but I gravitated towards the science of the outer world and that of our inner world, human biology.

I would have become an astronaut in a heartbeat if it weren’t for the fact that I wore glasses at the time (pre-laser days), had reactive airway disease (I blame second hand smoke), and got motion sick in the car. Probably the latter was the most important exclusion factor. Regardless, I gravitated (pardon the pun) strongly to the idea of being part of a team of individuals who were committed to discovery and exploration, and to bring these findings back to home on Earth.

It is ironic, then, that I now see myself as another kind of astronaut: that of a neonatal care provider. The team I work with is a widely diverse group of other neonatal care providers that range from bedside nurse to occupational therapist to social worker to cuddlers. Although there are many different team-based sports in medicine, I would hazard to guess that we stand up among the best of these teams in terms of the amount of integration and cooperative support we require to deliver the best care to our patients. We combine both acute and chronic care of our patients, and that sets us up for a more diverse team too.

Like astronauts, we huddle together (literally we do, in our unit each morning, to discuss the unit and upcoming events) and we come together during crises to just get the job done. At UCSD we enjoy high fidelity quality video reviews of high-risk resuscitations twice a month, and occasionally we will see a difficult resuscitation go incredibly smoothly, and yet the entire team is very quiet. Now although we teach our team and team leader to talk and script out each minute, it is amazing for me to watch 3-4 members of our team execute flawlessly what needs to be done with hardly a word spoken. Sometimes these teamwork elements are difficult to describe and therefore difficult to teach, but you know it when you see it.

 

“Like NASA, when there are very delicate and time sensitive processes,
we favor the development of protocols.”

 

So what makes an astronaut besides teamwork? Like NASA, when there are very delicate and time sensitive processes, we favor the development of protocols. Many would agree that NICU is full of them. These are the handbooks and guidelines that we pour over every year and update to establish how we are doing different medical pathways. Some may suggest we suffer from a form of “guidelinitis” but I think if anything, we are heading into even more standardization of practice, not less, in the future.

Another element that we avoid and discourage in neonatology is the “cowboy” mentality ­—  something that would be detrimental out in space. Interestingly quite a few movies capitalize on the rogue astronaut to make this point. In the NICU, someone who wants to do something completely different is often brought back to the median by the experienced team and told that that is not how we do things. Ask any newcomer to the NICU and they would agree. This pressurized response is wonderful for trying to keep to a standard which is an increasingly important overall goal for neonatal care. Occasionally though, we do see some outliers, and I would admit that all too often these are rogue neonatologists, but I have seen some cowboy/cowgirl nurses and RT’s too.

I use the astronaut versus cowboy analogy frequently when we are recruiting for neonatal fellows. Right now we are in full gear for selecting our future neonatal fellows for our 2015 program. I oversee our program and feel a great deal of responsibility in getting the selection right, especially when it comes to finding the brightest and best people who can work together with the teams of people we have at two main hospital sites. In the interviews I routinely emphasize the importance that our selection process is designed to pick out the future astronauts rather than future cowboys/cowgirls. I tell them more than practically anywhere else, neonatology is a team sport. The dynamic, multilevel communication and exchanges that go on during any given day sometimes appear near explosive (or implosive, depending on how you see it). Yet most of the time the energy is amazingly channeled into optimal decisions to make babies better. Good and efficient teamwork is essential.

Similar to astronauts, we know things and share things with the team that are hard to translate for others outside of neonatology. Many times I go home after a day at work and am simply speechless in how to respond to my wife’s query about how my day went. Where do I start? How can I capture the essence of the many volatile to tender moments that I participate in each day? How crises came and went throughout the day like the tides, and our team moved through these adrenaline rushes almost subconsciously (similar to ending up in the parking lot in the morning and not remembering how you got there)? There are many, many moments that the team suffers and cheers through together that simply cannot be fully shared (and not just due to HIPAA violations), and this strengthens the team that we are.

Recently I was given a personal success from a colleague who was told from a set of discharging parents that they will remember me as the one who “saved their child’s life”. Nothing is more gratifying than getting such a compliment — but this type of accolade is accompanied by some degree of guilt, since it really was not me, but rather our team, that saved that child’s life. Due to the historical hierarchy we have in medicine, this fact often gets lost.

Last week, I read a wonderful letter by Dr. Susan Hall from Kansas City called “Appreciate your NICU nurse: A letter from a neonatologist” (http://www.kevinmd.com/blog/2014/09/appreciate-nicu-nurse-letter-neonatologist.html). This letter refers to numerous moments in her neonatologist’s life that she was appreciative of the nursing care and compassion that took place, often many times that went unnoticed. So much of what she wrote was dead-on to my personal experiences and highlighted the specialness of this profession. Since we recently celebrated National Neonatal Nurse Day, it seems fitting that we take some time to appreciate our neonatal nurses and all that they do. And for that matter, it is equally important that we also celebrate all the other members of our team who we spend so much time with, intimately involved in making babies better each day. Because only with the strongest and most cohesive neonatal team can we go home each day and be able to say, “Mission accomplished!”