Surviving the NICU: A physician documents her journey

Ready to get a firsthand look at the roller coaster of emotions that is life in the Neonatal Intensive Care Unit?

Join me as I sit down with Dr. Susan Landers, a seasoned neonatologist and author who takes us through her thrilling 34-year career.

In her book  So Many Babies, My Life Balancing a Busy Medical Career & Motherhood, Dr. Landers delves into the pressure and teamwork intrinsic to this medical field and navigates stories of her most memorable patients and their parents, including a set of triplets and a baby with an inoperable birth defect. 

Dr. Landers also opens up about her journey as a working mother in a demanding field, the balancing act she performed between her career and family life, the challenge of being a female physician, and her approach to approaching retirement are all laid bare.

This episode offers a rare peek into the world of neonatology and the highs and lows of working motherhood.

Transcript

Speaker 1: 0:05

And so I think, part of the reason that modern working women are so burned out, as they keep trying to be perfect when, in fact, there is no such thing as being a perfect mother or a perfect career mom. It's life is just full of twists and turns, and we are asked to deal with every one of them.

Speaker 2: 0:34

Hi friends, this is Read and Write with Natasha podcast. My name is Natasha Tynes and I'm an author and a journalist. In this channel I talk about the writing life, review books and interview authors. Hope you enjoy the journal. Hi everyone, and welcome to another episode of Read and Write with Natasha. Today I have with me Dr Susan Landers, who is the author of the book so Many Babies. This book is the story of a neonatologist I hope I pronounced this right who raised three children while practicing medicine full time. Neonatology is the intensive care of critically ill newborn infants. The author's practice influenced her experience as a mother and she's thrived during her 34 years in the NICU. So, dr Landers, dr Susan, so happy to have you, I can't wait to hear about your work, your fascinating work, your life saving work and a bit about your book. So first, dr Landers, if you can tell us a bit about the book so Many Babies, what is it about and why did you write it?

Speaker 1: 1:54

Thank you so much for the invitation and I appreciate being here. I love your work and I've listened to the podcast. My book so Many Babies was intended to give people a peek into the NICU, the neonatal intensive care unit, where 10% of newborn babies will spend some time. Most newborn babies are healthy and stay in the nursery or stay with mom and go home and everything's fine. But 10% of newborns are born with a birth defect or they become sick after birth or they're born premature or sometimes many of those things together. And for those unlucky children, those unlucky babies and those shocked parents whose children need care, those children go to the NICU and life in the intensive care unit is not like life in the nursery or with mom rooming in. It's filled with ventilators and lines and tubes and medicines and treatments and phototherapy and parents who are upset, scared, sometimes terrified, sometimes guilty.

Speaker 1: 3:16

And I wanted to write a book that told the story of life in the NICU from the perspective of a doctor. I did that for 34 years and some of the nurses. I include their stories and their impressions, and a few of the parents. I picked my favorite patients with whose parents I developed long-term relationships over the years, for example, a set of triplets who were born at 24 weeks just patient, and I took care of all three girls for six months and I was there at their delivery and I was also there to send them all home. And I got to know those parents really well and I wanted to tell their story because they were sick and they all got better. They were sick in different ways and they all responded to treatment and got better. Their mother helped me set up a breastfeeding support group in the NICU and so there were special patients, special parents who had really impacted my life and the life of other caregivers in the NICU that I wanted to tell those stories, and so I picked out some stories that were great examples, good outcomes, not so good outcomes. There's the story in there of a baby with an unoperable birth defect who lived on peritoneal dialysis for about 18 months in the NICU before her death. There's another story of a baby who has severe brain damage and, despite the clinician's advice to the family to provide palliative care, comfort care, the father wanted everything done and everything was done and the baby ended up being unseeing, unknowing, unable to feed, spastic, cerebral palsy and shed by a tube. So the outcome was tragic.

Speaker 1: 5:20

I wanted to tell those stories because that's what goes on in the NICU. There are lots of big preterm babies like 34-weekers, like your twins were that sail in and out of the NICU and mated an IV for a few days or help with breastfeeding. But the majority of patients in there are smaller preterm babies. They have birth defects, they have infections and their parents are given the most difficult phase of their life to endure. We're learning more and more about how having a baby in the NICU affects mothers especially, and many of them become clinically depressed. And we can pick up on that depression as we're taking care of the babies every day. So those are the sorts of things that I wanted to portray to readers about the NICU.

Speaker 1: 6:23

In all honesty, when I finished my career, our theory burned out and I had sort of a negative image of all those years in the NICU.

Speaker 1: 6:31

But as I sat down to write and as I recall those stories of favorite patients or patients that were impressive and talked to their parents to get permission to tell their story all the parents gave me permission. By the way, they all said, sure, tell our story, we want people to know my perspective changed a bit and I decided that I could tell as many happy stories as I could tell tragic stories from the NICU. I didn't want people to think that all the outcomes were bad, because they're not. Most of the outcomes from the neonatal intensive care unit are good outcomes. Babies grow and thrive and go home with their parents and grow up to be normal children. But I wanted the public to get a perception of the kind of work we do in the neonatal intensive care unit, the the teamwork that's required. I couldn't do my job without good nurses, respiratory therapists, social workers, lactation consultant chaplains. It's just the epitome of teamwork in a hospital, in a medical setting, and so I wrote the book to try to portray those aspects of so many babies.

Speaker 2: 7:58

So what do you say? That the book is a bit sad. I mean, you said that there were happy stories, but in a sense it's people in pressure cookers waiting for their kids to survive. It's intense, you know, it's stressful and how would like. Why would people want to read something like a book that might depress them a bit? Why do you I mean, what was the reaction that you got, especially from parents either went through this or they're thinking about having a baby, because if I was going to get pregnant, I'd be scared of me.

Speaker 1: 8:43

Yeah. No, I think this book is not for expectant parents. I think it would be too scary for the average couple having a baby, expecting everything to be okay, and I initially wanted the stories to portray realistic outcomes. It is a bit sad. Some of the stories are big, sad, others are more joyful.

Speaker 1: 9:12

But as I recall those stories, I wanted to also reflect how those cases affected my life. I was a mother, I was a working mother with three children, and I had this wonderful but intense high stress job. And so, as I recall the stories and began to write about where I was in my motherhood journey, I could tell how the stresses from work or a good period, lack of stresses from work helped me be a better mother. I could tell stories about when I pulled back from working full time to take care of a child who had a challenge going on a medical issue. I could tell stories about how I got too wrapped up in my work because my patients always came first.

Speaker 1: 10:15

The doctors have this mentality that the patient is paramount and you put your family second and your spouse third and yourself on the bottom of the list, and that's the way we're trained, and so I wanted to give people a perception of how physicians work. Many, many physicians do these sorts of jobs and we saw that in the pandemic Natasha. We saw CR docs and family medicine docs and pulmonary docs and ICU physicians for grownups suffering with a load of extremely sick people. And so during the pandemic I was watching saying I'm kind of glad the public can see this, because doctors and nurses give so much of themselves, sometimes to the detriment of their family, and my story, I think, is a great example of that. I asked all my three children they're now all grown young adults If I could tell their story and how my job affected my ability to be a good mother to them when they needed it. And they all said, yeah, mom, it's okay.

Speaker 1: 11:42

I mean because they know that I worked more than the average mom, and so I think the story, my story, also speaks to career women, women and high stress jobs, full time working mothers who are trying to do everything. It definitely speaks to over achieving women and over achieving time working mom, because we set out to do things perfectly and then reality hit. You know, I trained as a doctor and neonatologist long before I became a wife and a mother, and so I was a good doctor and I had been well trained and I knew how to do that. And then when I became a mother and tried to balance having children and then a full time job, it was more difficult than learning to be a doctor. It was, it written in many instances. It was for me, and if I didn't have my friends and a supportive house I would have struggled even more.

Speaker 1: 12:48

And I think those aspects of my story are worth reading for women who find themselves overworking, call to their career, enjoying a career, being fulfilled by career, but also being torn by the constraints of being a mother. That is a common conundrum that american women find themselves in right now. I'm not gonna say burnout and working mother is epidemic, and that's not why I wrote the book, but because burnout and working mother is so prevalent right now, I think my story and how I dealt with those issues Is very pertinent to lots of other working mothers right now. Does that make?

Speaker 2: 13:43

sense to you? Yeah, yeah, of course I mean. You know we all. Working mother suffers, you know, suffer from this. But for me, now your kids are going up, do you, do you feel guilty about working long hours now, like looking back?

Speaker 1: 13:59

yes, yes, I always felt guilty off and on, and as I wrote the book and told the story of my three kids and each had different challenges along the way I decided that I was not as guilty, that they had turned out to be good humans and independent and had forgiven me for being gone more than I was there, and so I sort of came to terms with being a good enough mother. I was a very good doctor.

Speaker 1: 14:35

I wanted to be a perfect mother, as many young women do, and I decided through it all, with the help of my husband, that I was a good enough mother. And what I mean by that is that I made accommodations in my work so that I could be there for them for the school plays and the swim meets and the orchestra productions and the dyslexia work up and the visit with the nutritionist, and so are the visit with the psychologist. So I was there for the big important thing and I cut my hours and I made, I adapted my practice so that I can be there when they needed me, but when they didn't need me, when they had good childcare, when they were in school, when things are going well, I practiced a lot, I worked a lot because I found my work Very fulfilling, and so it really is a paradox, especially for physician mom. We go into medicine because we love caring for patients and then we discover we also love our children and we have to leave them to go take care of our patients.

Speaker 2: 15:52

It really is that basic of a paradox If you go back in time, would you still do what you? What you did, would you work?

Speaker 1: 16:01

that's a great question. I would not work sixty hours a week, I would work forty. And I may even have chosen a specialty that was less stressful. General pediatrics is far less stressful than the on a tology, I don't know, it's hard to say.

Speaker 1: 16:19

My career was very rewarding and I enjoyed the intellectual stimulation. I enjoyed the intensive nature of my practice. You know this may sound funny to you but doctors really do get excited when they get to do procedures and things and patients respond and Things go well. It's kind of a little bit like doing surgery where the outcome is good. If you're doing intensive care and the patient turns around and survive, that's very rewarding Psychologically.

Speaker 1: 16:59

There are benefits to having a job where you feel Fulfilled often and you know writing books is nothing like that, unless you're a celebrity writer, I guess, or a or a well known writer, because you don't get your kudos until after your book is written. But I got my kudos at work Commonly frequently, sometimes on a daily basis, because my patients were so needy and their parents were so Stricken and traumatized by the experience of having a sick child. It was easy for me to get Into that process of being a healer, being a caregiver, and so when I was away from my children, I was that caregiver, and when I was with my children, I was a good enough mother.

Speaker 2: 18:06

I hope I don't think I answered your question perfectly, but no, I mean, I think you did, but do you think this is mostly a woman or a female issue? The girls like do you think if you you know male doctors feel the same? Girls if they work 60 hours a week?

Speaker 1: 18:24

I think women in medicine feel these pressures greater than the men. Lots of surveys among women physicians and nurses too, have shown this, and I think it's partly the mental load that we all carry. Some of it is just being female and having two ex chromosomes. My husband would leave the house in the morning. He's also a physician, a pediatric nephrologist. He'd walk out the door if one of the kids was sick and go to work and say I know you're going to take care of it and I'd go. Well, I could use a little help every now and then. And until I mean, it took me a while to learn how to ask him for the help I needed, but usually I could take care of it. And my list of things to do the school, the sports team, the neighborhood group, the play date, all those things that moms think about the costumes, the birthday presents, preparing meals.

Speaker 1: 19:32

We think about a longer list of things than men do, and women physicians who are mothers are like that and men physicians who are fathers carry less of a mental load. I believe that's true. I have two friends who are general pediatricians who found what they considered the perfect prescription. They have a very busy practice. They each work three days a week and they're stay at home moms four days a week with their one has three boys and one has two boys and they say that is the perfect prescription.

Speaker 2: 20:15

Like part time, so it is part time.

Speaker 1: 20:17

Yeah, and that interesting yeah.

Speaker 2: 20:22

I mean we do, we do what we can to to to survive. So the book here. I just want to go back to, to the book. So many babies. What was the reaction to the book from readers?

Speaker 1: 20:38

Well, so far, readers have liked the story. Many have been surprised about some of the tragedies in there. Working mothers who are career moms have, and nurses have told me that they like my stories because I allow myself to be vulnerable, to tell the stories of my personal struggles to be a good enough mother, and many young career women have said they found my stories to be reassuring. What I mean by that is I could walk around the NICU at night after the work was done and chat with some of the moms and they would tell me stories about whether or not they were having trouble with another child and since they were in the hospital, that was really typical. And then we would talk and I would tell them stories about my kids and challenges. And so many times they would say, oh, come on you, your children are perfect. You're a pediatrician, you know how to do all this. I'm go, no way.

Speaker 1: 21:50

None of us are perfect. None of us know how to be a good mom or a good working mom. We're all flying by the seat of our pants and every single one would say that's amazing, that a pediatrician would admit that they're not really perfect at being a parent. And so I hear people say that my stories are reassuring because if I could make those mistakes that lots of women make mistakes, especially when you're balancing full time work and a family, it gives them a little bit more permission to be human. Does that make sense?

Speaker 2: 22:31

Yeah, yeah, did you get any negative feedback?

Speaker 1: 22:36

No, not, that was given directly to me. I didn't even get any negative reviews. Okay, interesting, but my book is not a big seller, it's I mean. So it was favorably reviewed. I had a Kirkus review. That was very positive.

Speaker 2: 22:56

Oh, that's good, Kirkus is good, yeah, yeah.

Speaker 1: 23:00

I think memoirs are kind of a hard type of book to make work sometimes and I ended up just telling my story honestly, hoping that people would be interested in what it was like to be a Neku doc and a mom all at the same time. And maybe that kind of book isn't written for lots and lots of people. Maybe that kind of book is written for only certain people and, in retrospect, natasha, throughout this whole process, the book was published in 21. I started writing in 17, I think, 2017. I think writing the book was more for me than for anyone else. Yeah.

Speaker 2: 23:51

And I wanna talk a bit about the publishing process. So this was published by Morgan James Publishing. You're actually the fourth author from Morgan James Publishing that I interviewed on this podcast so it seems that it's a very popular publisher and I just wanna see how did you end up with this publisher, what was your publishing journey? Did you send pitches to agents and how did it work for you?

Speaker 1: 24:21

I sent a manuscript book proposals to many agents. I was accepted tentatively by a New York agent and she based on my first chapter, which told the story of my personal struggle with premature labor and threatened premature delivery as a young neonatologist and a young mother, and she read that chapter and said this is gonna be a great book. I want you to just tell this one. I want you to just tell this one story. And I said, well, that's just a tiny little story. I mean, I have this whole life Anyway. So this high powered New York agent dropped me, which I found very discouraging, and I continued to look around for agents and I found an agent who was interested and he said I don't think I can sell your story to my publishers, but I know that Morgan James will be interested in your story.

Speaker 2: 25:27

Well, why do you think the New York ones dropped you Like? Why do you think what did they want?

Speaker 1: 25:32

They, circulated my book proposal among young women agents in their group. It was you can I can tell you the name of the group if you want to hear it, but anyway and they said this is a great story, her writing is very good, people will love these stories, but she has no social platform, no social media platform. And so the message that I got was if you're not an influencer, if you don't have a big audience on social media, your writing doesn't count.

Speaker 2: 26:12

That's too bad, I know it is too bad and I had imagined if they said the same thing to Stephen King on your first story.

Speaker 1: 26:20

Really.

Speaker 1: 26:21

Well you know I had talked to the chief operating officer of Children's Hospital National Medical Center and got his advice and he gave me the name of his agent and he had written a book. He's a pediatric surgeon and he had written the same type of book Good cases, bad cases, good patients, great parents, problem patients and having a life and being a pediatric surgeon. And I loved his book because I could identify with so much of it. And when I approached his agent she said I can't sell your story without a big social platform. And so I heard that from two good agents. But when I finally got hooked up with Morgan James, they offered me what's called a hybrid publishing deal.

Speaker 1: 27:18

I had to put up $5,000 of my own money to get the publishing process going. I had to pay my own editor and I had to do my own marketing. So it was no piece of cake to be published by Morgan James. I'm glad that I met them and I loved the people working there. They're very nice and they did a good job with my book. But I had to pay my own editors two editors and I got good editors. Stephen Harrigan, who's a well-known author here in Austin, recommended an editor for me. I hired a publicist to help me with marketing. That was $15,000. I don't think in retrospect that the marketing worked. Whether we were targeting the wrong audience or not, I'm not sure. So I have a little bit of a negative feeling about how you get a book published and sold.

Speaker 2: 28:35

That's why sometimes I talked to a lot of authors and majority of them mentioned similar frustrations. I think where we're going now is either you get picked up by the big four now they used to be big five and that's very market driven. What the market wants, it's a business. The market wants certain political stories or culture or social issues. That's the only thing that they would accept. So they accept very, very few and give them a book deal. Then the hybrid part where you have to chip in, and then there's the self-publishing. For me, the more I listen from authors, I feel like self-publishing is the way to go.

Speaker 2: 29:27

Because I had a small publisher and then I ended up self-publishing my second book. I'll probably self-publish as well, because you're already going to pay money out of your pocket, but with self-publishing you'll have complete control. You get 80% of the royalties or, if not even more, you can do your own marketing as well, especially and you can learn that. So I don't know. I mean, the market is shifting as well. The publishing is shifting. Ten years ago there were no hybrid publishers. There's either, like they used to call them, vanity press, and then there was small press. So it is shifting and some of the self-published authors are making a killing for certain genre like romance and paranormal and mystery. So I mean, let's wait and see where we go with this, but I think there's a lot of shift happening when it comes to publishing and the authors might just want to self-publish and be control.

Speaker 1: 30:44

Well, how do you think most people write books? Do you think they write books to sell them, or do they write books because they love writing?

Speaker 2: 30:55

So for me, I always wanted to write a book. I always felt I had a story and that was the first one. I mean I knew I was. You know, like sometimes when you're young you dream of becoming a best seller or whatever, but then you realize that it's really more the journey rather than the destination. And then you tell the story and then you realize you're not going to become a millionaire out of publishing books. And when you get this out of the way then you sort of relax and you realize for me, a book is part of my branding as well, you know. So I write nonfiction, I publish, I teach.

Speaker 2: 31:39

I have a podcast, so that becomes part of a long-term goal. If I make money from it, great. If I don't, then it's fine. You know so and that's where I am at this point. But I want to continue to publish books and, you know, experiment and see. But the idea of you just you know being in a cabin in the woods writing and becoming a next, you know, best seller is probably really, really fortunate.

Speaker 1: 32:10

Right right. You know, Well, I understand that writing a book contributes to your brand, your presence as an author and consultant and coach or other things that people do, but I'm 70 years old and I have oh well, you don't look it, you look great, Thank you.

Speaker 1: 32:40

And I have had a very long and wonderful life and I don't really need a brand. For a while I thought about doing other things helping other working mothers, creating a course or having workshops, things like that and so writing a book helps if I want to do that sort of thing. But I'm retired and I would really like to enjoy my retirement, although I do like writing, and so I'm torn as to whether or not I should continue to write essays, blog posts, a newsletter, whether I should write another book, tell happier stories. I don't know. I mean, what do you tell someone who's 70 years old, who's retired from being a physician, who's written one?

Speaker 2: 33:38

book. I mean, I would say follow your gut honestly, and what do you want to do? What would make you happy? So, for example, this book would open the doors for speaking events, training events, all of that, if you really want to do that. But if you want to enjoy the retirement life and just go on a cruise and not bother about any of that stuff, what makes you fulfilled? Like for me, I will probably want to continue to write. I don't know, I probably think differently when I'm 70. But I would probably want to continue to do it because we're at different stages of our life and at 70, you offer guidance and wisdom that others do not have at 70. So, and yeah, I would say, you know you're at this point of your life, you're free to choose right. You're not bound by a boss or by you know children, you know you're. So what would fulfill you, what would make you happy? What would and I would follow that route and you know I follow it now.

Speaker 1: 34:57

That's very solid and very perceptive of you and that's where I find myself right now writing some essays, posting on medium, writing a blog, talking to people who contact me after reading essays on my blog and I don't know if my heart is still in it enough to be on the speaking circuit. That's a lot of work. I did enjoy the process of writing a book. It's the most self-reflective activity you can do is to write a memoir to really go back and make sense of all the different phases of your life and how you managed through those phases and what got you through and what impeded your progress as a human being.

Speaker 1: 35:52

You know lots of people talk nowadays about mindset and especially important for achieving career parents is to have a growth mindset, and as I read the book and as I've talked to people, I am steadfast in my belief that one of the reasons I got through a stressful career in raising three kids is that I always had a growth mindset.

Speaker 1: 36:20

I always thought information, I always wanted an expert opinion, I always wanted more knowledge, and I used my intellect to help me deal with certain aspects in my career and in my mothering, and so I think that's an important message to tell younger parents.

Speaker 1: 36:44

I'm very concerned about how we use the internet these days and social media and how working parents are getting information from some social media sources that's not professional advice and sometimes it's not good advice, and they're finding conflicting information and they're more and more confused about how to be a good parent, and so it does bother me a little bit that the internet offers so much information to parents that is not expert or professional. It also bothers me that working mothers are seeing images of perfect mothering and well-dressed children and beautiful homes and lives that are going seamlessly, when in fact, we all know that's fall. Nobody has a life like that, and so I think part of the reason that modern working women are so burned out as they keep trying to be perfect when in fact there is no such thing as being a perfect mother or a perfect career mom. It's life is just full of twists and turns and we are asked to deal with every one of them throughout every phase of our life. And I don't think social media helps those perceptions. I think it harms those perceptions.

Speaker 2: 38:21

Yeah, I mean, one thing you can do is just an idea about a YouTube channel where you talk about your experience and then this way you can have an open communication with the people that you want to reach. And it might sound daunting with all the production, but you can always hire a virtual assistant or someone who can do that work for you and you just focus on the delivery. So that's if you're done writing books. But that's just an idea and the word needs your expertise, so that's also important. So any final thoughts before we conclude? Any tips for working mothers who are struggling to have it all?

Speaker 1: 39:15

I guess my favorite tip for working mothers who are struggling to have it all and make it work is talk to your spouse or partner and talk to your friends. Those connections are so crucial. We all know we're supposed to exercise and eat well and get proper sleep and try to do some relaxing activities, but it's the communication and the social connection that is so crucial for women, and if we're at home working remotely, we don't get that, and I want women to think about how, by our very nature, we love to be together. We love to talk with one another.

Speaker 1: 40:02

Love to be supportive and we're so empathetic and especially if you have a friend who's going through what you're going through, please talk to that friend. Please talk to your husband or partner so they'll understand what you're worried about. Those social connections are just crucial for working moms to make it in today's world. Not Instagram, not Facebook.

Speaker 2: 40:35

I love that I read something once which is women need other women more than they need.

Speaker 1: 40:42

It's the village. It is the village. No sure that we all perceive. When we don't have one, we know we need one.

Speaker 2: 40:55

Yeah, well, this, this been wonderful. Dr Landers, and for anyone who's who's reading or watching or listening, please check out Dr Susan Landers books so many babies, especially if you're a parent, current parent or someone who's struggling with life work balance, and you can also find Dr Landers work on her website. And thank you for watching and listening to another episode of Read and Write with Natasha. And until we meet again, thank you, natasha.