I Don't Know How You Do It

Doctor's Notes: Life in the NICU, with Dr. Rachel Fleishman

February 13, 2024 Jessica Fein Episode 55
I Don't Know How You Do It
Doctor's Notes: Life in the NICU, with Dr. Rachel Fleishman
Show Notes Transcript

What's it like to have families counting on you in their time of greatest need? How do you separate work life from home life when every workday is literally life and death? How can you bring more humanity into what it at its heart is totally scientific?

Meet Dr. Rachel Fleishman, a Neonatologist, Assistant Professor of Pediatrics, and Director of Narrative Medicine. 

Dr. Fleishman's shares what it's like to care  for sick and premature babies in the neonatal intensive care unit (NICU), explaining how the practice of narrative medicine – analyzing patients' stories – helps her empathize with families and see their babies as more than just diagnoses. She shares insights into making space for open communication, overcoming self-blame, and cherishing the roles every member of the professional and family team provides.

We also dive into  Dr. Fleishman's journey from studying literature to becoming a physician, how traumatic births have informed her care, and coping strategies for healthcare workers bearing witness to suffering. 

You'll learn:

  • How to see people as multifaceted individuals with stories, not just diagnoses or problems. 
  • Why you need to care for yourself when caring for others.
  • How to move forward with hope and help instead of  blaming yourself for situations outside of your control. 
  • How to leave work at work, even in the most intense work situations.
  • And so much more...

Learn more about Dr. Rachel Fleishman:

Website
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Music credit: Limitless by Bells

Transcript

Jessica Fein: Welcome. I'm Jessica Fein, and this is the “I Don’t Know How You Do It” podcast where we talk to people whose lives seem unimaginable from the outside and dive into how they're able to do things that look undoable. I'm so glad you're joining me on this journey and I hope you enjoy the conversation. 

Welcome back to the show. Before we get into today's episode, I want to invite you to be part of my book launch team. As you've probably heard me talk about, my book, Breath Taking, a Memoir of Family, Dreams and Broken Genes, will be published May 7th.

In the meantime, I'm putting together a group of people who believe in the book and want to help spread the word. If that's you, I would love for you to join. You can learn all about it at my website, [00:01:00] jessicafeinstories.com, jessicafeinstories.com. Now, onto today's episode where I have the pleasure of introducing you to Dr.Rachel Fleishman. 

Rachel is a neonatologist in Philadelphia focusing on family centered care in the neonatal intensive care unit at Jefferson's Einstein Hospital, where she is also an assistant professor of pediatrics and director of narrative medicine. We have talked to so many people on this show who have spent time in the hospital with their children, and it was fascinating to hear a doctor's perspective on the patient doctor relationship, what she wishes parents knew, and how she brings together her passion for literature and her practice of medicine.

Without further ado, I bring you Dr. Rachel Fleishman.

Welcome, Rachel. I'm so happy to have you on the show.

Rachel Fleishman: Oh, I'm so excited to be here. Thank you so much for having me. 

Jessica Fein: You have such an interesting career that I can't wait to talk about, [00:02:00] and you're also such a gorgeous writer, and I had the opportunity to dive into a lot of your writing, and so I really want to talk about both.

But as we start off, let's introduce you to the audience. You are a neonatologist, an assistant professor of pediatrics, and director of narrative medicine. 

Rachel Fleishman: All true, yes. 

Jessica Fein: That's a lot. 

Rachel Fleishman: Maybe, but maybe not. So I'm a pediatrician. After medical school, I did my pediatric residency training and then I went on and I was drawn to taking care of hospitalized children.

I have always valued and found a lot of personal and professional fulfillment in building relationships with families, which is In many ways, easier to do in the hospital, where, I mean, there's plenty of work to go around, it's not like we're lounging about, but the pace of the hospital, different than the sort of 15 or 20 minute visit appointments that you have in a clinic, allows more unstructured and informal time to really get to know [00:03:00] parents.

When I was a resident and the children were not infants, which now my patients are all babies, I was able to build relationships with the children as well. And I was fortunate to have exceptional mentors all throughout the hospital where I was a resident who helped me to value and understand the benefits of really deep rooted communication and relationships with parents and families.

I then went on to do my neonatal intensive care fellowship, so I spent three years just working in the neonatal ICU. We take care of sick and well babies. I attend emergency deliveries. and high risk deliveries. And then if babies require intensive care, they can stay sometimes for a few hours or for some of our premature babies, they can be there for weeks or months.

And that really provides the opportunity to get to know parents and support them through the parenting journey that is the NICU. 

Jessica Fein: You know, it's so interesting because when you talk about getting to know parents and how you can get to know them at a totally different level when they're [00:04:00] residing, if you will, in the hospital as compared to, you know, a 15 or 20 minute quote unquote well visit, it's not only from where I'm sitting that you're spending this extended time with them, but you're also with them by definition in a crisis as compared to the checkup that you have in the doctor's office.

Rachel Fleishman: That is definitely true. And when I was a resident, I would go every Wednesday afternoon from 1 to 5, and I had my clinic, and I had my mentors for three years, and they were amazing. And they were like, just wait. Over time and over years, you'll build meaningful and deep relationships with these families, just as many people who have never had complicated pediatric issues for themselves or their children have deep rooted connections to the pediatricians that cared for them in childhood. And I have developed that relationship as a parent with my son's pediatrician. So it's not that that is not meaningful and impactful, just, it felt so flimsy to me as a trainee. And it is true that when parents have kids in the hospital, there are a lot of complicated questions [00:05:00] and existential, emotional things going on for those families.

And I have always been drawn into those. complicated communications and relationships since I began as a physician in training. 

Jessica Fein: So interesting having been on the other side, having been the parent who resided in the hospital with my kids. I'm so fascinated by your decision and your commitment and your preference to be working in that environment.

Rachel Fleishman: There are lots of pediatric subspecialists. I'm sure, as you know, as a parent, and I think that that refrain is not unique for many people who do any type of pediatric subspecialty. It tends to be about the families. 

Jessica Fein: You are the Director of Narrative Medicine, and I'm not familiar with that term. What is narrative medicine?

Rachel Fleishman: Narrative medicine grew out of work by Dr. Rita Charon at Columbia, the Columbia Medical Center, and she is a physician who also had a PhD in English, and she postulated and has gone on to build a rigorous [00:06:00] academic discipline that physicians have much to learn both from studying literature and looking at the structures, tones, and perspectives of stories, and then applying the analytic skills that, say, an English class, an English professor would teach, to the way that we listen as physicians to patients.

In medical school, there has long been a sort of a current of diagnostics. There was something called the Flexner Report in the early part of the 20th century. I don't remember the exact year. And that report placed this emphasis that doctors should be scientists and should really study what's called pathophysiology or the both healthy and ill processes within the body.

And from that, you get an understanding of very individualized treatments. You can get a lot of biochemical science, drugs, studies of disease. So if you understand on a cellular or mechanistic level what's going on within the human body, there are [00:07:00] ways to develop novel treatments that can then help cure people.

And that is all well and good and very important. But there are other existential things that physicians do. And when people are sick, not just children or parents of sick children, but any human. We all get sick. We are all living beings. There is this other piece that we want to be healed and seen. And there is suffering to be identified with when people are ill, either their children or themselves.

And narrative medicine, and it's not the only way to do it, but the aim is really to help physicians have a construct to see their patients as people with stories as opposed to people with problems. And if you can identify the patient, be it a child, and again, I'm a pediatrician, so that's my framework, as somebody who's not just a problem strep throat, but as somebody who has Pain, and that pain is impacting how they function at school, or how they are going to work, or impacting their marriage, or their relationships, or whatever is [00:08:00] going on around them, which we all know because we all get sick, and we all have discomfort with that sickness, whether it's an acute or a chronic illness.

And trying to find a way to help physicians understand that so we can build more meaningful connections and relationships with families is one aim of that work that is going on within the medical or health humanities of which narrative medicine is a part. 

Jessica Fein: Okay, first of all, I love the idea of really thinking of the person not just as their diagnosis or their symptoms or whatever.

And I had that experience when we arrived in the Pediatric Intensive Care Unit when my daughter was just turning nine, the doctors saw her as we arrived. And so they had this one vision of her and as the mom, I so wanted them to understand who she was before they met us in this dire situation. And I would try and tell them, you know, but [00:09:00] everybody was so busy.

And so what I ultimately did was I hung photographs. Around her room in the hospital that showed her doing all the things she loved to do and who she was because I felt like if they saw her that way, I believed as the mother, you know, they would understand what we were trying to get back to. And so when I'm listening to you describe narrative medicine, it resonates with me on that level.

When you say that you look at literature in this discipline as kind of a basis. Are there specific books? I mean, as an avid reader and a writer, I have to ask, are there certain books that you're like, yeah, we always teach this one to show how this whole thing works. 

Rachel Fleishman: So in my role at work, I take care of babies.

I take care of their parents. I work intimately and integrally with nursing with obstetricians, and I train doctors in training. So I have my own neonatology fellows who are apprenticing to become neonatologists, and I have pediatric residents as well as medical students that sort of walk around the NICU and [00:10:00] learn as we are all caring for the same patients.

And part of the pediatric training hat that I wear have been running conferences where I'm using skills from the health humanities. So close reading of stories and texts to get us out of the framework of all we need to be doing is talking about patient problems. I send out one story or essay each month.

This year I've been sending out stories of illness. And I send them to every physician that works in our hospital and if they want to come discuss, then they can. I've been doing this for several years now. It's been a great forum for physicians to have a space in the workday where we can talk about both how we feel in relation to what these published authors are telling us.

Because these are real people, but they're also not in front of us. To talk about a published piece is very different than to talk about an actual patient. And as we talk about the language that the authors choose to use to describe whatever the [00:11:00] issue is, to the piece that we're reading today is about addiction and the author has been in recovery for some time.

It's a piece from the Paris Review. He's having a tooth extracted and he needs a prescription narcotic in order to legit recover from the pain of having a tooth sought out of his skull. And he's talking about his, how that is, and his commentary on how addiction, you can be healed but never recovered or recovering and I think these stories are really important for us as doctors to listen to, but they have to be presented to us in a way.

Jessica Fein: As I'm listening to you, I'm struck by the fact that you are also a writer, and I think your education was even more, before you decided to pursue medicine, you were more in the literature humanities area. So it's kind of bringing those together, right? How did you make that change?

Rachel Fleishman: That's a fascinating question.

I feel like I've come full circle, but it took me, you know, decades to get back to my roots. I went off to college. I was going to be a creative writing student. My college didn't have a creative writing major, but [00:12:00] you could take a whole bunch of classes and they would give you what they called a special concentration.

I think that's since changed, but that was sort of the option available to me at the time. My father, who's an engineer, was kind of like, okay, that's all well and good, Rachel, go ahead, fine. But you need a degree in something where you can take care of yourself. Like you're going to this very fancy, expensive school.

When you graduate, you got to pay your own bills. And so he pushed me to continue my science courses, which I also very much enjoyed. And the sort of natural outgrowth of being an avid scientific scholar was then medical school. There are physicians who are called to become physicians and there are others.

Who, there's this stature of being a doctor, and I don't know that it, it's so much that I was chasing it as much as there was this promise that I would have this secure job where I could provide for my family, and that is true for all the hard things and magical things that my career has given me. It's also made possible for me to pay my own bills, which is not a [00:13:00] small thing, 

Jessica Fein: And which is certainly not guaranteed as a writer.

Rachel Fleishman: Right, I don't think that my father's advice, as painful as it was to hear when I was 18, was wrong. So I have two boys, they're 14 and 11, and as they have gotten older, and their needs have shifted, and they're in school during the day, and I am a shift worker, who works weird hours, nights, weekends, days sometimes as well.

I've been able to create space for myself to write and find meaning and sort of reframe and understand a lot of what I witness at work on the page. It's helped me to process a lot of the hard things that I see through a particular lens. And I never stopped writing, but to find the courage to begin publishing some of that writing took some growth and maturing, and I also needed to be at a point in my journey as a mom and in my career where I had space to do that.

Jessica Fein: Well, it's so interesting that you talk about how you process through the writing. You wrote [00:14:00] that you are quote, “continually supporting newly postpartum parents in the aftermath of births that did not go as envisioned. I am not the doctor. I am their children's doctor. It is possible that I could keep sending testing and assigning diagnoses for their babies.

and simply shut down their stories about all they endured with a succinct pronouncement. Talk to your own doctor about that. But I have a front row seat to childbirth gone awry, and my only therapeutic instrument is my willingness to make time to listen to these stories.” Okay, I think that is so gorgeous.

And as I read it, I was like, I wish every doctor understood the value of listening to these stories. Reading that really helped me from the parent perspective, but I'd love to hear what you were thinking about that particular piece. 

Rachel Fleishman: Thank you for taking the time to read my writing. That's the first thing I'm always struck when people do, so thank you for that.

I think it's a lot of what we're talking about. It's similar [00:15:00] themes that I've learned from exploring the theory behind narrative medicine. I think that the more that one opens one's mind to sort of this idea of humanism and the humanistic position and being present for the people around you, it's hard to then un hear it or un see it.

And I think also, you know, I've had experiences in my own life, my own parenting, my own childbirth, that allow me to relate to people because of my own things. It is true that no parent ever wants their baby in the NICU. I often say to parents, nobody ever wants to meet me. Nobody ever envisions when they pee on the stick.

Welcome or not the pregnancy, nobody ever thinks like, oh, my baby NICU. I mean, every once in a while women have had many prior preterm births or see it coming. But most parents, the NICU is not part of their calculus. And so every time that I walk into a room, it comes as some sort of surprise or unfortunate occurrence.

Something is going [00:16:00] on. And so while I acknowledge that it is perfectly possible to have a healthy baby, I also acknowledge that access to healthcare is inconsistent. And my role is such that I am only involved when there's a reason for me to be there. I'm not at a healthy vaginal delivery with nothing going on because I'm not needed there.

And so I, that's not, that whole world of normal childbirth, that's not what I ever see. And I'm not there to help the mom. I'm there to take care of the baby. And so there's some learned tunnel vision because if I watched and sort of got drawn into all the laboring and all the operating that's going on around me, my focus, my role would be very challenging.

And so that professional growth. I mean, happened when I was in training, you can only get drawn in to the thing that you're doing. But having been on the other side of that and had my own children, in the aftermath, there is some space to acknowledge, like, yeah, this stuff is hard. Like, it's all really hard.

It's hard as a mother, it's hard as a woman, it's hard for fathers and parents to [00:17:00] have their children be sick or have needs. That's not the mainstream narrative, right? That's not what we're told.

Jessica Fein: Yeah, exactly. And you just alluded to the fact that your own delivery was traumatic. How did that inform your medical practice?

Rachel Fleishman: I spent much of my first pregnancy, like, you know that there are all these things that go on in pregnancy, and the choice that I made was just to pretend that none of them existed, and not, again, with like, the willful suspension of disbelief, like, you either go down the rabbit hole of worry, or you just absolutely shut it down.

I went about pretending that I was Not, I mean, I knew I was pregnant, right? But I wasn't, like, consumed with pregnancy related things, and I just was working and parenting. So after I finished my residency, I was working for a few years in urgent care, also at the hospital where I trained, and that was when I was pregnant.

Suddenly I was working part time and growing a human. And so I had all this free time that I I had never had [00:18:00] before. And so I was doing things like cooking and taking long walks and hanging out with other adults who didn't work 80 or 90 hours a week. And so when I went into labor and things went awry, I was both terrified, um, I ended up with an emergency c section.

I can like say that those words as if I would write them in a chart, but the process of living through it was very hard. and then creating space afterwards to sort of understand nobody did anything wrong. It wasn't about blame. I think there are many women who have a lot of self negative connotations or self judgment about not being able to have a vaginal delivery.

That wasn't sort of where I lived. I just lived in this spot of, you know, it was, it was frightening. It's frightening to have people calling for extra personnel into your operating room, and it's frightening to not hear your baby cry. And you, you know, as a physician, you've been on the other side, you see these things happen, but you never really know what it is until it's you.

Jessica Fein: And I think that's maybe also why I've known women who say they [00:19:00] want female doctors because they want Doctors who have gone through the same experiences now, not necessarily emergency, but if you are, for example, pregnant, you might want a female OBGYN because you want somebody who can use their own personal experience to understand what you're going through.

Rachel Fleishman: I have known many amazing male and female physicians in every arena of medicine. I don't know that gender is the primary thing that drives a comprehensive and compassionate and dignified delivery or healthcare. I do feel, for me personally, that as a pediatric healthcare provider, I believe in my soul that I am better at my job because I am a mother.

I personally, if I had never had children, would not provide care the way that I provide it had I not lived through the things that I've lived through, and were I not raising my own children. I can only speak for myself. I [00:20:00] cannot generalize beyond me. 

Jessica Fein: No, I appreciate that and I wonder if the flip side is true.

Do you think you're a better mother because you're a physician? 

Rachel Fleishman: I don't know about that. I remember when my son was born, my first son had colic and I, you know, as a resident had had a pediatric clinic and I would tell my mom, you know, it's okay that they cry a lot. But then when you're holding your own crying, screaming infant that just won't stop crying, you know, I would call my mom who at the time lived.

3000 miles away and be like, mom, he won't stop crying and she'd be like, Rachel, you're a pediatrician. I'm like, I know, but he still won't stop crying. I could like tout every benefit of breastfeeding and like deeply believed it, but I had no idea that breastfeeding was so hard. I had no idea. So I think in some ways Yes, but not really.

I think my husband, he's now an administrator, but he was a middle school teacher for a very long time, and now as we have a teenager and a tweenager, I think teaching has made him a phenomenal father. I know when to take my kids to the doctor and when not to, but I don't know that it has helped me, that my pediatric training has made [00:21:00] me a better parent.

I mean, maybe, but maybe not. 

Jessica Fein: I, too, am married to a teacher, so I can definitely appreciate that, and I will tell you, when it comes time for writing essays and homework, I am so glad that I am married to a teacher and that that can be his department. I also love what you say about calling your own mom. My husband and I adopted our three children in Guatemala, and I remember with our daughter, my husband had to leave the hotel room to go buy this special formula, and it was the first time I was alone with such a little baby. She was six months. But to me, that was a very little baby. And I was so petrified. I was so afraid. What if, what if she needs to change her diaper or whatever? 

Like, I didn't know what I was doing. From Guatemala, I called my mother, who was in Boston, by the way. I mean, it was a long distance call, and I made her stay on the phone with me until my husband got back. So I love how we turn to our own mothers. 

Rachel Fleishman: I do think a lot of our strength as mothers comes from our own mothers or maternal figures.

Jessica Fein: It's interesting when we go back for a minute [00:22:00] to what we were talking about in terms of you being the patient's doctor, meaning the baby's doctor, and yet the main person there in the room is the parent. And from the parent's perspective, I know I always felt it was a very delicate dance because I didn't want to be quote unquote, bothering, annoying that doctor.

I wanted the doctor to like me. It was this feeling like if the doctor liked me, they were going to try harder. I realize how crazy that sounds, particularly talking to a doctor, but it was how I felt. On the other hand, I knew I was my child's advocate. And I cared much more than any single other person in the world, except my husband, about what was happening.

And it's hard, I think, for parents to balance that, balance wanting to be liked and not be a pain and not come off as, you know, quote, unquote, hysterical, but also to be able to be that advocate and be fighting for what you believe your child needs.

Rachel Fleishman: I think it is really hard. I think that I was [00:23:00] fortunate from the moment that I walked into my pediatric residency to be presented with this idea of family centered care.

I was taught from my very first day as a resident that parents are the center of the care team. And I've never unthought it. I've never thought to question it because it has always just seemed true. Now, your very real and common experience of sort of that interpersonal dynamic is tricky, and different people have different personality types, different psychology, and so different parents approach that relationship differently, but I know a very few pediatric providers who have not been conditioned, taught, trained to value the input of parents.

Jessica Fein: That's really good, good to hear. And I talked to a lot of parents whose kids have been in the NICU, the PICU, and for people who might not know, you know, Pediatric Intensive Care Unit is [00:24:00] the PICU. And this is a common thing parents feel. I even had one guest on the show who was talking about how she would choose her attire very carefully when she was going to meet with a new doctor.

She wanted to be thought of in a certain way. What would you tell? parents whose kids are in these intense situations who are worried about this relationship with the doctor. What advice would you have for them? 

Rachel Fleishman: That's so tricky. I mean, I can speak most clearly about the NICU because it's where I now have spent more than a decade of my career to say that every NICU parent is both postpartum and going through their own hormonal and physical bodily shifts of having just given birth and needs to spend time taking care of themselves, which I think holds true if you have an older child with complex needs.

You still need to take care of yourself. The needs may be different if you're not just recovering, you know, from a four hours ago C section, [00:25:00] right? But it is very hard to advocate for your child if you are not physically taking care of your own bodily needs. Eating, sleeping, finding ways to de stress, which are really personal and really challenging.

Like if one of my kids were in the hospital and a doctor told me like, go home for the night, that's hard. Different people are going to respond to that differently. But if it's a two day hospitalization, it's very different than if it's a two month or four month or, you know, some children both in the NICU and older spend a very long time in the hospital.

And as adults, we need to breathe outside air, and we need to eat food that does not come from a hospital cafeteria. So part of it is that ability to somehow navigate your own physical and emotional needs while also showing up for your child. In terms of relationship building with physicians, we're all people.

Parents are people, doctors are people, as are nurses, who are a critical part of any inpatient care team in any hospital ward. And I think just [00:26:00] being aware that the doctors and nurses are people just like you, with their own kids and their own, like, maybe they forgot their coffee in the car, and if they're going out to get it, that's not because your kid isn't important, it's because they need their coffee to get from 7 p.m. to 7 a. m., or whatever it is. And so just, I think, all of us in hospitals, both whether we're there working or whether we're there because of our own needs or our kids needs, just. Approaching each other with best intentions can get very far. I don't know if that is helpful or not helpful. 

Jessica Fein: I think it is, and I'm so glad you brought up the nurses, because I know that what we felt was our real relationships when we were there living in the hospital with our daughter, our real relationships were with those nurses.

It was such an eye opener for me just to be there for an extended time and to see the role that the nurses played. And I, in fact, wrote an article. At the time when I was there said that said no offense to you as a doctor, but it said the nurses are running the show and I meant it with all respect [00:27:00] for every player involved, but it was just how critical those nurses were.

They were the ones that had a little bit of extra time to. be with us, be with our daughter. They were the ones who could sit in the middle of the night and hold my hand. They got to know us at such a personal, powerful level. And so I think it's so important to recognize what a critical part of the team they are.

And then of course, you know, it was always the big thing, like, what do you mean you're not going to be on the next shift? Who's going to be on the next shift? You know, that was always the big thing. Who's on today, right? 

Rachel Fleishman: For people who have not spent time on an inpatient hospital setting, like the NICU or the pediatric wards, either the PICU, so for sick children, not after birth, but basically once you leave the hospital after you've been born, if you then have an emergency that requires intensive care, you end up in the PICU.

And so it's a different age population, and it's a different set of physical and bodily problems that are cared for in the PICU. But yes, the nurses are a thousand million billion percent integral to the operation [00:28:00] and care. And I think people saw that, you know, if you've never been in a hospital in COVID, where you had all these sick adults.

And there was a little window, you know, where the media was able to sort of come into some of these adult, I always say adult as a pediatric, but like adult intensive care units and see how hard it is, the sort of physical and emotional work that nurses do. And if you've never been in an inpatient setting, you may not realize that, yes, that is a very real and critical part of health care.

As physicians, the role is different. So it's not less or more, it's different. Our role is to interpret the patient's physical exam, labs, x rays, information from parents or caregivers, and then develop a treatment plan for the day. And that is an intellectual role that is a large part of our training, is to be able to figure out [00:29:00] what is the best next step.

It's not the only role, but it's the sort of most proximal and the primary reason that we're there. And a lot of that work is It's not done in front of the family. Maybe the families in certain settings will be present for rounds where some of those decisions are on display in a language that's full of jargon and doesn't often make a lot of sense if you don't spend a lot of time in the hospital.

So it's not that it's meant to be kept, it's just, you know, we speak a weird language in hospitals because we have to communicate in a way that is, you know, conveying a lot of complicated information in a very short amount of time in order to then figure out what to do. 

Jessica Fein: I'm wondering from your vantage point if there are a couple of things that you wish families in your world, so in the NICU, if there was something that you wish families knew, something that you find is a misconception and you would like parents to know.

Rachel Fleishman: I think many, not all, but many parents, particularly mothers, in the [00:30:00] aftermath of a birth that didn't go the way that they expected, have a tendency to blame themselves. I think it comes from both societal ideals of what childbirth should be, So there's not a big, huge space out there in the mainstream world to talk about birth complications or sick babies or sick children.

People don't often want to hear about it. And the patriarchal structures as they are in our society convince women that we should be able to control our own fetal growth. Like, somehow, because we're pregnant, if we make good choices, we should then be able to promise that our child will be healthy. And there's a large body of epidemiologic literature and literature looking at access to healthcare that tells you that that is false.

And so, when babies are born sick, it is rarely, if ever, directly related to maternal choices or maternal behavior. It is that we as women are human, we are natural beings, and to [00:31:00] gestate a pregnancy is hard, and sometimes biology happens, and people give birth early, or babies are born sick, and to blame oneself is common, but also, you know, I mean, we're all human, we have feelings that are not necessarily grounded in reality because that's how we feel, so it's not that it's wrong, but I just, I wish that every NICU parent would hear that it is not your fault. It's never your fault. It's just where we are. And the NICU is a gift.

Our work, my work, the neonatal intensive care work is there so that we can then, in most, nearly all scenarios, send babies home when they're ready. When they've healed from whatever it is, when they've outgrown their prematurity, when they've come through whatever the illness is. And PICU care, or hospital care for children, is similar.

We are there because without us, All of these kids would have no hope, right? Look at how far we've come to have pediatric health care, to do everything we can to help children and families thrive in [00:32:00] whatever way our bodies or their bodies allow. I think sometimes the lens gets shifted in this way that people feel hopeless, when actually the care is the hope.

Jessica Fein: How do you spend your work shift in these most intense scenarios? And obviously, you are witness to a lot of tragedy, a lot of suffering. How in the world do you leave work at work when you go home to your own family? 

Rachel Fleishman: Oh, years of practice. Some days are easier than others. We become accustomed to the problems that we see every day, right?

So if the building across the street fell down, the day that it falls down, it seems shocking. But if nobody builds it back up for four years, then you just look and there is pile of rocks. And I'm not trying to equate humans to buildings or lives to rocks, I'm just trying to say that you become accustomed to the problems around you.

And so, you develop a framework through [00:33:00] which these things all seem normal, because they are normal. Premature birth and sick babies are part of my everyday work world, and so I understand that they happen. They happen every single day to lots and lots of people all over the world, because they do. And if I dwelled on that, then I would not be able to do my job.

So some of it is frame shifting, some of it is habituation. I also, over the last few years as I've been writing, the things that I have sort of needed to process for myself have found a way, through the process of revision and self questioning and taking stock of the world around me, have found a way to process to find some deeper meaning for myself as a person.

And also as a physician and a mom, but mostly as a human being. Right? Because it is hard. It's all very hard. 

Jessica Fein: Well, I, again, having read some of your writing, can see how you're working that through, but also offering through your writing such a gift to people in all [00:34:00] areas of the team you were talking about, whether that's other practitioners, whether that's parents.

So I'm very excited for your book to actually come into the world. I think you said it's some time away, but when that happens, we'll have to have you back on the show so we can talk. Just about that and the work you're doing and the approach and the mindset and the attitude that you bring. I know what an incredible impact it must make on everybody in your ecosystem.

So thank you for sharing your story with us and for being on the show. 

Rachel Fleishman: Thank you for your really kind words and for having me as a guest. It's been awesome. 

Jessica Fein: Here are my takeaways from the conversation with Dr. Fleishman. The whole concept of narrative medicine is a giant takeaway for me. I had never heard of it before.

Rachel later shared this quote with me by Dr. Rita Charon, the narrative medicine guru, which says, quote, “Indeed, it may be that the physician's most potent therapeutic instrument is the self, which is attuned to the patient, through engagement on the side of the patient through compassion and available to the patient [00:35:00] through reflection."

Which leads me to the takeaway number one, seeing people as multifaceted individuals with stories, not just a diagnosis or problem, fosters deeper understanding and compassion. And that's true everywhere, not just in the hospital. 

Number two, as a caregiver, you cannot properly care for others without also caring for yourself. We all hear that and it can feel impossible, but it is absolutely critical. 

Number three, don't blame yourself for situations that are out of your control. Focus instead on moving forward with hope and help. Number four, remember doctors and nurses are people too. Approaching them with empathy rather than assumptions can strengthen relationships.

And number five, compartmentalizing can be the key to staying fully present at work and at home. 

I know how much great content is out there and I do not take your choice of listening to this show and being part of this community for granted. Thank you. And please take a moment to rate and review the show.

We're in the top 3 percent of podcasts globally and we are just getting started. And remember, if you want to join my book launch team, visit jessicafeinstories.com. Have a great day. Talk to you next time. 

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