Hello every one 

I hope you all doing very well 

i want to talk with you about an important topic in our daily work .

Stress with Nicu .

we all face difficult time , difficult parents as well , but  i want to share these two stories which give you a clear view about the massive stress we are facing here in libya .

the first story about abnormal baby delivered to a commander of a strong militia who pointed his gun toward my head when his sun passed away in his first day of life .

he refused the congenital abnormality we had discovered about the baby and insisted that it is a medical mistake that caused the death .

i escaped the clinic that day and saved my life ! 

Police intervened very late but a father's relative had successfully convinced him about the abnormality ( CCHD ) .

 

The second baby is the one i wrote about in the virtual Nicu here in our forum few weeks back .

a suspected case  of perrie robin sequence who had pneumonia since birth  but didn't respond to many antibiotic 

he stayed in our Nicu for 32 days (m.v) then passed away .

His clinical course complicated by sepsis and Vap .

what we are nowadays is accusation about the possibility Nosocomial infection and the whole family is asking for indemnity because they said there wasn't sepsis initially .

we have an infection control team who are doing there best in fighting infections but cases and incidents happen from time to time .

 

those two cases i  have shared is just an example for a routine challenges 

feeling pain and lost is a routine here . sometimes i feel very depressed and it affect my life in every aspect .

i have a wife and two kids . my wife praying every duty to god for me  not to have any trouble so i can come back to the home psychologically sound .

My country in a state of chaos since 2011 and i don't expect it to be any better in the near future .

 

so , 

What is the most difficult situation you been through ? ofcourse related to nicu ?

To what extent theses challenges affect your personal life ?

 

Dear @Aymen Eshene, thanks for sharing these stories and their impact. Contexts are different but I think anger, disappointment and distrust  are common roots for conflicts regardless of where we work. I hope there are few personal threats (and at least less guns!) in many settings. I have only felt threatened myself once and that was very long ago.

Some years ago I was part of a complex resuscitation scenario, and the infant died after about 1 hour of full resusc (when we halted). Despite that autopsy revealed congenital lung hypoplasia as the cause of death, the communication with parents went completely off the route and everything became very "inflamed", and we were all reported by the family to the authorities. I can just say that many of us had bad feelings during this process, despite that we knew that everything had been done by the books, medical-wise. I think what drives us to feel so bad (as I see it from the amateurish psychology perspective) is that we still worry that we actually did something wrong, that the errors will be discovered and that we then will get into real trouble, including newspaper headlines.

With time, I have been thinking about two aspects of these situations:

• with "seniority" one gets more responsibility, gets involved in more complicated scenarios, but is generally also regarded with more respect from parents, BUT also face more of these hard situations (communication-wise)
• deaths, severe morbidity and suffering of infants and/or parents still feels - at least I do not get used to them although I think I have developed my ways to manage

Although it may sound far too simple, I believe that parental empowerment (i.e. familybased care) is one strategy that can help to attenuate strong reactions, so that parents feel engaged and involved in the NICU, hopefully creating a greater awareness and understanding about what's going on with their child. And most importantly, a good team spirit of all staff categories is essential where problems of this kind can be shared in mutual respect.

@Aymen Eshene, I have to say it is very brave of you to write and share the experience you have had ...its like living it again!

I believe sharing such difficult scenario helps to unload and makes you realise that you are not in the boat alone. I do not think, any doctor, working in neonatal intensive care, would have not had a day, 'at least once', when they felt, I should quit and run away! It happens but we carry on....

I felt scared just reading your story. Imagining myself in your situation gave me goosebumps. My family would have possibly asked me to quit etc ...who knows! I feel very sad and stressful when things go "not as planned" in NICU ...It impacts personal life in a big way. Its exactly same as when you have a good day at work and you feel happy at home too. 

We had one parent threaten us 'I will hide in the parking and when you leave after work at night, Ill get you there!' Its was horrifying to go the parking lot, for days ....even after knowing that he he had left to live in another country. 

The degree of vulnerability for the doctors and nurses in cases of baby's death and disability cannot be quantified.  Despite giving your best, in certain situations, outcome cannot be any different. We however automatically start feeling responsible for things that didn't go as expected. Self doubt, confidence breakdown etc all come together as a dark cloud and hover around for days and weeks. The fear of 'who will now get the blame for all that has happened' doesn't help either! ...But we still carry on doing our jobs with much zeal and passion because this is what we believed in ...in the first place! The vast majority of good outcomes and happy families we see routinely versus one or two unfortunate events! ...probably not enough to yield that much power to dictate a change in career path for anyone.

I think its sometimes good to take a short break, unwinding your thoughts and feelings go a long way... and why not take psychological support! Why to shy off from that! The amount of physical, emotional stress we go through in day to day intensive care job, this is the least we can do to help ourselves. 

I agree with @Stefan Johansson...involving parents and family at a very early stage (eg Resuscitation, parents should be there.. ) regular updates, encouraging them to make and take informed decisions in the care of their newborn, can all help...in understanding the situation. The clarity of whats happening with "my baby" and "why are we doing this?" gives parents more insight into their child's clinical condition and management.  

I feel the pain you and your family are going through and hope that you are able to overcome this hard time soon.

 

@Aymen Eshene Dear Aymen, wishing you and all the medical team in Libya a more peaceful life.

Chaos, illiteracy prevalence, public awareness, military / organizational or racial apartheid and lack of legal and human rights are major contributing factors for the violence against medical practitioners. However, its out of our hands as medical practitioners to overcome these factors. It will take time to overcome that and needs a lot of public and government work.

However, what is doable on the ground is what @Stefan Johansson and @Schumz have kindly outlined concerning personal confidence, family trust, sharing the family in the management of their infant, frequent updating them what is happening and what is being done, letting them see how everyone is doing their best near bed side if possible, sharing them in decisions when possible and time allows you, explaining in details the risks and the expected management  in advance if possible eg; prematurity, CHD and etc when present. Requesting one of your medical team member to be responsible of the infant`s family providing them with the updates, risks, etc if you have enough human resources at the time. Antenatal and perinatal consultations facilitates families to accept and appreciate the medical service provided to their infant and helps them know what to expect. Update families with every planing for an intervention eg: sepsis workup, why, what could be expected and risks of morbidity and mortality associated to such a intervention and diagnosis if positive. Ask for their written consent in invasive procedures and verbal consent in front of two of your medical team eg, if on phone as the parent to repeat his or her consent to side nurse on the same phone call.

I would recommend you to read "Antenatal Consults  a Guide for Neonatologists and Paediatricians" by Mark W Davies et al. its a good source helped me arrange my thoughts before taking to families.  Good luck.

 

 

 

What scary experiences for you and ongoing stress working and living in such a volatile country. I pray for peace in Libya and safety for you and your family.

I have also  twice felt physically threatened in an NICU.

The first was a mother who threatened us with a knife and wouldnt let us near her baby. We discovered she had post partum psychosis.

The second occurred during a national nurses and teachers strike. Strikers gained access to the hospital and two of my colleagues were attacked in the corridors. They were told that all nurses must leave the hospital. We were informed that the strikers were going ward to ward forcing nurses out. I made a decision that I would not leave and was fearful of being physically attacked. Fortunately the strikers never came to the NICU.