As we were playing in the courtyard by the post-natal ward I heard that click that portends the overhead speaker coming to life.
“Code Blue Neonatal. Code Blue Neonatal – 4 south”
There must have been 24 newborns on that ward but in that split second, I knew the call was for mine.
We walked around the corner to our room and there was Rosie, grey, not breathing, a skilled hand delicately applying a face mask. My wife and eldest were in tears standing next to her. As the team grew bigger, room was made for me to come to the front, and become a part of it.
To lose one child at birth is a tragedy, to lose two……
My blog posts are often inspired by real-life, with dates and names changed. When Rosie was born I already had a series on normal neonates in mind. I was going to take photographic records of every poo stained nappy, every normal neonatal thing I could find. But her respiratory arrest halted that. Now, a couple of years later I am able to take a step back and reflect on some of the most (clinically) important aspects of that day.
Quiet is calm
I used to think that a leader was the person with the loudest voice, the one barking orders. This is probably a holdover from growing up under the shadow of a father in the armed forces. I have been to many arrests – both adult and paediatric – and have found that those that are the quietest are the best run.
In her book Quiet, Susan Cain talks about the power of introverts, and about how they can be team leaders and effective ones at that. So how does that happen? Introverts tend to listen more than they speak, observing the environment around them, and drawing on all of the verbal and non-verbal cues presented to them. Because of this, they tend to hear what others have to say, reflect on it, and use that information as needed. A calm resuscitation is not the product of one person, but the whole team, sharing a single mental model. The team leader allows others to shine when needed and takes their ego out of the equation. How many times have you been at a resus when the doctor in charge of the airway says, “I just need one more try” as the patient continues to desaturate.
Noise is just wasted mental energy.
You will be remembered
I wrote last time about the importance of how you make people feel. I think it is so important a point that it is worth reiterating. I don’t know how many patients I have seen since I qualified but I do know that, to them, their interaction with me was possibly one of the most important things that happened to them that day. To me, they may just be another patient with chest pain or another snuffly child with mild bronchiolitis that I want to send home but to them or their parents, I am something else. I am the voice of authority, the voice of reason, the voice of validation, the voice of kindness, the voice of compassion – and they will remember that.
After an intense round of tests in the NICU (including the LP that I stayed for) it was time for the hard-working dayshift to hand over to the team that would be taking care of the unit overnight. My wife was catching some much-needed rest and I was sitting beside the crib. As the team shuffled by and formed a long line behind the small pink bundle the neonatal fellow gave handover.
“And this is her father, Andrew”
“We’ve met before actually. It was about five years ago. You were the consultant that told me my first daughter had died.”
She visibly reeled before averting her eyes to be led to the next bed.
Praise where praise is due
In medicine, we are used to feedback – negative feedback usually. It’s that look from the department director as she calls you into the office, “You remember that patient….” that automatically makes us wonder what we have missed. But it doesn’t always have to be like that. Adrian Plunkett and the Learning from Excellence movement has led to an increase in reporting of positively deviant behaviour but it has yet to make much of an impact over here in Australia. What I think is more powerful, though, is hearing from the patients and parents themselves. I made it a point, once the stress levels had died down somewhat to write a thank you to the team, via the CEO of the hospital. I felt it important that not only did they feel valued but that the executive also knew that they were valued. Next time you or one of your loved ones are a patient, try it.