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“The weekend after Isabelle’s discharge, I take my shoes outside onto the driveway. The sky is a brilliant blue, and green tinges of leaves poke through shells of buds; the wind slips through my fleece. I scrub the spots of blood with an antibacterial wipe, and tan shoe polish comes off instead, leaving the burgundy spots haloed and dark. Next, I smear shoe polish into the leather and brush away the brown curds of polish with a horsehair brush. The drops of blood remain.
All these years later, those spots are still there, and I think of Isabelle every time I wear those tan shoes. And like those marks on my shoes, memories of babies and families remain etched in my mind—stories of failures, tragedies, successes, and joys. Our patients become an inextricable part of our lives. We carry their stories with us.”
Benjamin Rattray is a neonatologist.
He shares his story and discusses his KevinMD article, “Our patients become an inextricable part of our lives.”
Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Benjamin Rattray. He is a neonatologist, and he wrote the KevinMD article “Our patients become an inextricable part of our lives.” Welcome to the show.
Benjamin Rattray: Thanks so much for having me on, Kevin.
Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?
Benjamin Rattray: Yes. So I practice neonatal medicine, the newborn critical care medicine, in Greensboro, North Carolina, and I actually did partly grow up and did my training in Southern California. Before that, I was born in New Zealand, and that’s sort of how I got into medicine. My mom was a district nurse in New Zealand. Sometimes, on my days off school, I would end up joining her, and we would drive around and visit some of the patients that she was caring for. So I think that’s where I got my initial interest in and love of medicine.
And then I actually ended up starting as an English major in undergrad, switching into premed, did medical school in Southern California, and then was fortunate enough to match into Duke for pediatric residency, stayed for my neonatology fellowship, and then here I am practicing in North Carolina.
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Kevin Pho: So tell me some of the reasons that you chose neonatology as a specialty.
Benjamin Rattray: It’s twofold. So one is, I love the intensive care aspect of it: getting to work with your hands, quickly intervene and make quick decisions, and then see those decisions impact patient care, whether it’s a ventilator change, changing a drip rate on pressors, something like that. But then the really unique aspect of neonatology is our patients actually stay with us in the intensive care unit for some time, so you get to develop these long-term relationships with the patients and families. So you kind of get the best of both worlds.
Kevin Pho: So tell me about some of the challenges and rewards of neonatology.
Benjamin Rattray: So the challenges are that when it’s tough, it’s really tough. We’re really lucky, because in adult critical care, I think it’s tough a lot more than it is in neonatology. But to lose a baby is always really significant, really traumatic, and there’s a lot of grief involved. So I think one of the really tough parts is just the emotional aspect of the job, guiding families through, sometimes, withdrawing care. It can be really challenging. But then the rewards are huge, to get to impact a baby’s life and a family’s life really for the duration of that child’s entire life, because you’re right at the start of the trajectory of their life. So I think there are huge rewards as well.
Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s a story, “Our patients become an inextricable part of our lives.” Now, for those of you who get a chance to read your story, can you just walk my audience through it and share the story of why you decided to share it?
Benjamin Rattray: Yeah, so the story is the story of a baby who is delivered with the complication of shoulder dystocia, and so essentially the baby gets stuck on the way out. We get called emergently to the delivery room and find that the baby has no heart rate. We end up giving epinephrine, chest compressions, intubation, all of those kinds of things, and we actually get a heart rate back. Then we take the baby upstairs to the intensive care unit, where we use therapeutic hypothermia for the first three days. The baby’s really sick, has respiratory failure, seizures, but ultimately does really well and is able to go home. We have good MRI findings that are not showing brain injury. So it’s a really good patient outcome for us. It’s certainly not always the case in that sort of clinical situation.
But what I find is that there are a couple of drops of blood on my brown work shoes from the delivery. So I find myself one day sitting down on the driveway with some shoe polish, trying to clean my shoes, and I find that those dots will just not come off, those couple spots of blood. And so what I really thought about was how our brains and our memory are like that. Our patients become etched in our memories, and they change us, and they always stay with us. So every time I put on those brown dress shoes, I always think about that baby.
But I have all these patient stories that I really carry around with me and that I think about, and in fact, I put that collection of stories into my book, When All Becomes New, and it’s the story of these babies from neonatal intensive care. I think that’s one of the things that really makes medicine what it is. It’s not a day job that you go in and you punch the ticket and you come home. I think it’s something that we always carry with us.
Kevin Pho: Are there any particularly poignant patient stories that have influenced you or changed you as a physician?
Benjamin Rattray: Yeah, I think there’s a whole host of them. I mean, certainly there’s a story of a preterm baby with sepsis, and unfortunately this baby died despite all the antibiotics, all the pressors. Her dad took his two adopted sons, put them on his knees, and then prayed for this baby as she was passing away. That image has always stayed with me, that image of the father with his two sons on his knees, and just his strength and his vulnerability in that moment while that baby was passing. That certainly made a really big impact on me.
Kevin Pho: I can’t imagine a situation more traumatic than a family losing an infant, and I know, as a neonatologist, unfortunately you do see a fair amount of those situations. And I can’t imagine it’s any easier for you. So I want to ask you, how do you have the strength to go through these situations multiple times?
Benjamin Rattray: Yeah, I think that’s a great question, and one that I’ve certainly wrestled with. I’ve certainly had crises along the way, a crisis of faith, which is in the book, as well as just those feelings of exhaustion and being overwhelmed by it. But I think ultimately what I find is, as clinicians, we can add so much value into these situations. We can notice, we can draw near, we can bear witness, and by doing that, I think that we get to have this really intimate relationship with people, and we can actually draw strength from that as well. And I think that strength, of knowing that what we’re doing can make a difference, in general, that’s enough to sustain us and keep us going.
Kevin Pho: Now, are there any lessons that you could share with your fellow clinician colleagues? They may not, of course, be in neonatology, but they deal in similar life-or-death situations. Any piece of advice that you could share with them that you could draw from some of the more traumatic experiences that you’ve been through yourself?
Benjamin Rattray: One of the things that really has helped me is reflection. There’s a quote that I love by an Israeli writer called David Grossman, and he says, “I write, and I feel that the correct and accurate use of words acts like medicine.” For me, it’s been that time of reflection, sitting down quietly, working through each of these clinical scenarios. I found that in training, we focus so much on morbidity mortality meetings, where we’re talking about, do we use the right antibiotics, were the vent settings right, etc. But one of the really important things, I think, is to both reflect and talk with each other, share with each other the more emotional aspect of medicine. That interpersonal aspect, I think, is a really important part of what we do, and I think we can actually create resilience by reflecting and by drawing near to the people around us.
Kevin Pho: So you mentioned talking and reflecting about that situation with your colleagues and with your friends, or with family. Give us an example of who your support network is, and who do you share these moments with?
Benjamin Rattray: Yeah, so my wife, she always knows, when I walk in the door, what kind of a day I’ve had. She knows when I walk through, and if I say, “Yeah, it was a good day,” she knows everything’s fine. She can just read my body language, I think, before I say anything. I think she’s a huge support for me, and I think colleagues as well. There’s a lot of things that you don’t even really have to say. You can just say, “It was a rough night,” and people know. So I think those are the biggest sources for me.
I’ll just add one more thing to that, sorry, which is reading other people’s books. So, for example, reading Dr. Awdish’s book, In Shock, gives you all this information about the way that she deals with different things in medicine, and I think that can really help too. People tend to write down things that they wouldn’t necessarily say in person.
Kevin Pho: We’re talking to Benjamin. He is a neonatologist, and he wrote the KevinMD article “Our patients become an inextricable part of our lives.” Benjamin, for those medical students and residents who may be interested in going into neonatology, what kind of person should they be? What kind of characteristics should they have?
Benjamin Rattray: I think one thing that you have to be is detail-oriented. A lot of people in medicine are type A, and I think in neonatology that’s true to an extreme, because when you’re dealing with medications, you’re dealing with milliliters and milligrams, and you’re really doing the math on these tiny babies. But I think you also have to have the desire and the willingness to partner with parents, to work as a team. Neonatology is very much a team sport, so you have to be willing to partner with a team. I think those are kind of the main things.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Benjamin Rattray: I think the biggest take-home message is just that the emotional aspect of medicine is really important. I had a friend and a colleague who committed suicide during training, and I wish that I had spent more time talking with him, asking him how he was doing, instead of just focusing on the objective tasks at hand. And I wish I’d realized that that’s also true for our patients. We don’t have to have this professional distance from them all the time. We can talk to them, we can relate to them, draw strength from them, and they can draw strength from us. And I wish I’d realized that medicine is not just about the objective facts. There’s so much more to it.
Kevin Pho: Benjamin, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.
Benjamin Rattray: Thanks, Kevin. I really appreciate it.
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