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#174 - 🙂 Hope, Empathy and Professional Growth





Hello Friends 👋

Happy 2024! We kick off the new year with an exceptional episode. This week, we delve deep with Dr. Terri Major-Kincade, a neonatologist whose career is a testament to the power of empathy in medicine. Dr. Major-Kincade shares intricate details of her path, shaped by her sister's premature birth, leading to her life's mission in neonatology. She explores the complexities of providing hope in the NICU, the ethical dimensions of palliative care, and how personal experiences can enrich professional practice. The conversation also navigates the intricate balance of work and life in the demanding world of neonatal care. For specialists seeking to deepen their practice with empathy and evidence-based insight, this episode is a reservoir of wisdom and encouragement.

Happy Sunday!

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You can find out more about Dr. Terri Major-Kincade on her website: https://drterrimd.com


Short Bio: Dr. Terri Major-Kincade is a double board-certified neonatologist and pediatrician with over 23 years of experience as a Clinician in Neonatology and Pediatrics, Health Equity Expert, Perinatal Health Disparities Advocate, and Neonatal Palliative care/Perinatal Hospice provider currently based in Houston, Texas. She is a native of Baton Rouge, Louisiana, and holds a bachelor’s from Prairie View A&M University, and an MD MPH from the UCLA School of Medicine. She went on to complete her Pediatric Residency and Neonatology Training at UT Southwestern and UT Houston, and recently completed Pediatric Hospice and Palliative Medicine training at Baylor College of Medicine/Texas Children’s Hospital.  She currently serves as Associate Professor of Pediatrics, Medical Director of Pediatric Palliative Care and Hospice Medicine at UT Health McGovern Medical School/Memorial Hermann Childrens Hospital. With her expertise in health equity and racial health disparities, Dr. Terri has led several outreach initiatives to improve maternal and neonatal outcomes through national partnerships with the March of Dimes and served as Chair of the Steering Committee for African American Outreach for the State of Texas March of Dimes for 8 years. She serves on the national board for the Pregnancy Loss and Infant Death Alliance (PLIDA) and the Pampers Womb to World Advisory Board as well as the Medical Advisory Board for Push Empowered Pregnancy to End Stillbirth. She is a two-time Amazon Best Selling Author for her Book entitled Early Arrival: 9 Things Parents Need to know about life in the NICU, and Full Circle Moments: What 20 years in Neonatology taught me about Life, Love and Loss. She looks forward to the day when every baby is born healthy, every mother has an opportunity for a good pregnancy outcome and every family benefits from a legacy of equitable healthcare.

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The transcript of today's episode can be found below 👇


Ben Courchia MD (00:00.854)

Dr. Terri, Major King-Kate, thank you so much for making the time to be on with us this morning.


Terri Major-Kincade (00:06.565)

Thank you for having me. I'm super excited to be here.


Ben Courchia MD (00:10.634)

We're very excited to have you on. I've been browsing all Dr. Terri related resources for the past few days, and I'm very excited to have you with us. And I wanted to ask you so many questions. And I guess where I want to start is the inception story of how you became a neonatologist. I think you tell that story very frequently. It's fascinating. And I'm wondering if you could share with us a little bit.


What pushed you to neonatology? It seems like it's something you knew you wanted to do very early on in your life.


Terri Major-Kincade (00:43.269)

Yes, I appreciate that question. It's funny, sometimes when I'm giving the talk, I can see people in the audience actually telling my story for me. But I've known I wanted to be a neonatologist since I was four or five. My sister's a preterm baby, and she was born in 1968. We are only eight months apart because she was a preemie, and she was born weighing one pound, 24 weeks. She was born at a time when the preemies were not supposed to survive.


Daphna Yasova Barbeau, MD (she/her) (00:52.232)

Hmm


Daphna Yasova Barbeau, MD (she/her) (01:02.489)

Mm-hmm.


Terri Major-Kincade (01:12.281)

She was born at a time where parents could not come into the NICU. And my mother is fascinated that parents can come into the NICU now. She didn't have a name for three weeks. They just called her baby girl major because they were told that she would not survive. And so for me, my sister and I are the same age for three months of the year. And I've always, when I was little, I would be like, well, how am I the big sister if we're the same age? Like, what's really going on here? And that's when I learned she was premature.


Daphna Yasova Barbeau, MD (she/her) (01:16.012)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (01:20.035)

I'm sure.


Daphna Yasova Barbeau, MD (she/her) (01:25.02)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (01:32.2)

Hehehehe


Terri Major-Kincade (01:39.937)

I learned that when she went home, she was small enough to sleep in a shoe box. And so I have always been fascinated with the fact of taking care of humans who could fit in your hand, a human who could actually sleep in a box. And so I knew I wanted to be a baby doctor, but I wanted to be the kind of doctor that could take care of the babies that could fit in your hand, like my sister. And so then I found out later that those doctors were called neonatologists and I just kind of set my path.


right then and there that I wanted to be a neonatologist. So I always say that she's the first preemie I ever took care of. She's only five feet. So I always say, well, we didn't have TBN then, but it's okay. But I mean, she's a CPA, she's very accomplished and she doesn't have any of so many of the complications she could have had from prematurity. The other thing is she was born a couple of years after President Kennedy lost his son to prematurity. So, and President Kennedy's son was not that premature.


Daphna Yasova Barbeau, MD (she/her) (02:23.42)

Wow.


Terri Major-Kincade (02:34.329)

And he wasn't that small. He was five pounds and he was a 35-weeker. And so it was the death of President Kennedy's son that spurred on the development of neonatal intensive care in the United States. So I've always looked at President Kennedy and the loss of his son as providing a vehicle for my sister to even have a place where she can be taken care of and grow and be born and eventually come home. So that's why I wanted to be a neonatologist.


Daphna Yasova Barbeau, MD (she/her) (02:53.852)

Hmm.


Ben Courchia MD (02:59.202)

I think... I think...


think what's interesting about this, you mentioned this in your book, by the way, that we'll link on the episode, show notes, full circle moments. You talk about your sister and I was baffled to hear that number one, you say that not only did she survive, as you mentioned just now, she thrived and she even had access to surfactant, which I was reading this and I was like, 1968, that seems like way before most people got access to surfactant, can you tell us?


Daphna Yasova Barbeau, MD (she/her) (03:19.707)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (03:24.759)

Mm-hmm.


Ben Courchia MD (03:28.406)

how fortunate you guys were to have access to this therapy so early on.


Terri Major-Kincade (03:33.233)

So she was at a charity hospital in New Orleans, which actually is no longer here as a result of Hurricane Katrina, and was a part of the very early trials for surfactant use. And so she was part of the very early experimental use for surfactant, and that is why she's here.


Daphna Yasova Barbeau, MD (she/her) (03:40.904)

Hmm.


Ben Courchia MD (03:51.65)

Wow, that's amazing.


Daphna Yasova Barbeau, MD (she/her) (03:52.052)

Wow. You know, along that same lines, even something like that, being a part of a major clinical trial, it sounds like you're very close with your family, including your mom. And I wonder what it has been like for her to see your career grow, and I mean, in the spectacular way that it has, knowing that she had a baby in the NICU. You know, I always…


I wonder about parents. It's not just childhood. It's not adult. I mean, right there worried about us even, you know, until their last days. And so I just wonder what that's been like for her to see, uh, your career like this.


Terri Major-Kincade (04:25.125)

Yes.


Terri Major-Kincade (04:31.117)

One of the things that's so interesting for both of my parents is because my sister was born at a time where we didn't have family centered care in the NICU, they are fascinated when I give a talk, when I talk about all the things that parents are allowed to do now. My mom is fascinated that I harp so much on making sure that we make parents part of the team. They're not visitors, they're part of the healthcare team, empowering them as the experts in their child.


Daphna Yasova Barbeau, MD (she/her) (04:41.03)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (04:46.833)

Hmm.


Terri Major-Kincade (04:58.245)

We provide information so that they can partner with us in decision-making. Because they came, my sister was born at a time where they visited on Sundays. They visited on Sundays, they looked at her through a window and then one Sunday they said, okay, you can take your kid home. Like nobody did care about being, nobody talked about you taking a four pound baby home. Nobody talked about, we don't have four pound card seats. We weren't doing car seat test. Nobody said, oh, she can sleep in a shoe box. I mean, like, it's just hilarious. So there's a picture of my,


Daphna Yasova Barbeau, MD (she/her) (05:19.824)

Right.


Terri Major-Kincade (05:27.313)

parents holding my sister on their lap and me sitting next to them. And I'm just like, they literally sent my sister home, like this size. So she is just fascinated at the way that the field of neonatology has grown, but also fascinated that families are so embedded. Because she's like, because I'll say, well, she'll call me and I'll say, mom, I had a family meeting. We're getting ready for discharge. And she's like, well, what are y'all talking about? They're just going to take the baby home. Because she doesn't even realize.


You know, like, you know, there are a couple of things that we need to discuss prior to discharge. But, you know, at that point, they're just happy that they were able to take home a live child because as I said, they were told that no one was sure she was going to survive.


Ben Courchia MD (06:06.752)

It's-


Ben Courchia MD (06:14.494)

That's amazing. And what was it like for you to grow up with a sibling that was an extremely low birth weight infant? Because we know that these are infants that remain fragile in their early years and that could sometimes be stressful for not just the parents, but the entire family. I'm just curious about what was that experience like for you who was also trying to grow up at that time?


Terri Major-Kincade (06:44.273)

So what's really interesting is because we're so close in age, I've always felt like we were more like twins than a big sister because we were so close in age. The other thing is I was way more fragile than she was. And so we always kind of laugh about that because I was not premature. I actually, I normally share this with my, one of my interests is, Nick, you follow up. I always say I'm a neonatologist trapped in a pediatrician body. And one of my interests is,


sharing with families about the journey for their kids to develop. I did not start, I was over, I was almost 14 months before I took my first step. They had literally had another baby who was a preemie who was walking before me. I'm like, mom, why y'all didn't take me to somebody? I wasn't walking. Like, what the heck? Like, didn't y'all care? She's like, we figured you would walk when you're ready. I'm like, goodness, you know, like literally my premature sister was walking before me. I had a, I had a knee brace.


Daphna Yasova Barbeau, MD (she/her) (07:22.28)

Hmm.


Daphna Yasova Barbeau, MD (she/her) (07:37.498)

You not?


Terri Major-Kincade (07:41.521)

I mean, I had a back brace. I mean, my sister, like, I guess once she broke out of the incubator, she was like, I'm here, I made it. So she literally did not have those challenges that I had. So I never saw her as fragile, but I can tell you what it does do for me is when I'm talking to families, it's just so humbling for me to realize how blessed my sister is to be here because so many babies are not here, particularly being a black infant born in the United States. Just the fact that she,


Daphna Yasova Barbeau, MD (she/her) (07:48.229)

Mmm.


Ben Courchia MD (07:48.337)

Uh-huh.


Terri Major-Kincade (08:10.937)

was able to break through those odds. So it's very humbling to me anytime I meet a family who's navigating this journey because my sister is here, but I have many friends and family whose children are not here. And I carry those families with me.


Daphna Yasova Barbeau, MD (she/her) (08:23.553)

Mm-hmm.


We definitely want to talk, we want to have a big segment on just what you're touching on the disparities that we see in the NICU. But before we leave this topic, I mean, obviously empowering families is obviously a passion for you. You've spoken on it, you've given numerous lectures about it. And I wonder how much of your own family experience paints that picture for you.


Daphna Yasova Barbeau, MD (she/her) (08:56.348)

You know, for units that are struggling to integrate family-centered care, family integrated care, what are the very basics that we have to do every day for every family?


Terri Major-Kincade (09:08.317)

The main thing we need to do for every family is see the family. It sounds pretty basic, but when you're in an intensive care environment, especially when you're an intensivist, you tend to see the numbers first, and you see your job as translating the numbers in a way that the family can make a decision. We see the numbers first. We present the babies as numbers. I'm always amazed when I walk in and I say,


What's the baby's name or do they have other kids? Well, I don't know. The kids were there two months. We should know that. Because this child is a love member of a family unit and they're more than the numbers. And so I always, at least when I have learners, I try to pause and center the baby as a part of the family. So I think the first thing that we can do is just make sure we present the baby by name.


If you have family-centered rounds, a lot of people have rounds now where the parent is actually present and they're listening to rounds, which I love that, but they still have to listen to a bunch of numbers. And then at the very end we say, but do you have any questions? Well, no, they don't have any questions. I don't even know what the heck you just said. And so you can start rounds and say, do you have any questions? Because often the question they have is something very, very easy to address and has nothing to do with the numbers that we brought up. So I try to just...


start by naming the baby as a family member, acknowledging the parents as family members. Don't call parents mom and dad. I just, 23 years in the neonatology, I just learned this. I just learned this in pediatric palliative care last year to stop calling parents mom and dad. And so that's been life-changing for me because I was taught they may never get to hear their child say mom and dad, so they like it when we say mom and dad. But it's very unsettling for somebody to call you mom who was older than you.


and who is not your child. And I never thought about that. I learned that from a parent narrative. So centering families by seeing them first before you jump into numbers. And I think we need to model that for learners too. Cause learners come to the bedside with the numbers on rounds, hoping that you don't ask a question they don't know. But your question may simply be, when was the last time the parents visit? When was the last time they visited? And do they have other children? Are there other things they're worried about besides the baby here?


Daphna Yasova Barbeau, MD (she/her) (11:33.928)

Why do you think that you talked a little bit about learners and I mean you talked about modeling but what else can we do in the training of young neonatologists to really teach them how to empower people which is a whole different skill set?


Terri Major-Kincade (11:54.553)

Right, so I think some very helpful things in terms of how to empower is asking for permission to share information. So how many times do we walk up to the bedside? We have the head ultrasound results, we have the echo results, we have the x-ray results. If they're not actively dying, we have gotten all this information, we need to put it in our note. We need to be able to put it in our note that we updated the family. But what other information has the family received today? How heavy?


of a day hasn't already been. So just asking parents, is it okay? Hey, I'm taking care of your baby today. We have some new information. Is this an okay time to talk? I mean, that's life-changing. So I had a learner with me last week during a family meeting and we asked, we were talking about a baby who had a illness, but this was a prenatal consult. Baby had not delivered yet. We had gone through a number of possible pathways. And then at the end of those consults, we always talk about


what happens after death. Cause some families do wanna talk about funeral, cremation, et cetera. Some don't, but a lot do cause they're planners. And so at the almost what the end of the meeting, we said, we have one more thing to talk about. Are you okay with talking more? Is it okay if we share more? We talk about funerals end of life at this time. Is this okay? And the dad said, if it's okay, can we talk about that next week? This has been a lot and we wanna go and process this.


Daphna Yasova Barbeau, MD (she/her) (13:17.243)

Mm-hmm.


Terri Major-Kincade (13:19.737)

And so when we came out, our fellow literally said, oh, wow, I didn't know that we could ask them, I didn't know that we could give them permission to say no, I mean to say next week. And I'm like, the baby hasn't delivered yet. And you're already in a situation where you have no control. So even if a parent can say, I'd love to get that update, but my husband gets off at four, my wife gets off at three, can we just talk about this at 3.30? Normally we're talking to families because that's the time that works for us.


Daphna Yasova Barbeau, MD (she/her) (13:27.216)

Hehehehe. Hmmmm.


Daphna Yasova Barbeau, MD (she/her) (13:36.664)

Mm-hmm.


Terri Major-Kincade (13:49.649)

After rounds, I need to get the information in, I need to do it before sign out. But does it work for them? And so just asking people for permission to have a conversation, obviously if it's an emergency you can't, but asking for permission, asking people how they like to receive information. Do they wanna hear all the facts or do they just want the big picture? I always joke that I know when the dad is, or mom is an engineer because.


Daphna Yasova Barbeau, MD (she/her) (13:49.871)

Mm-hmm.


Terri Major-Kincade (14:13.285)

They want all the numbers. So like when you go to a restaurant, are you the person who wants to hear all the specials of the day? Or are you just like, look, what's good here? I don't want to hear everything you have on the menu. Just what is good here? Because you're stressing me out. So how do they want to receive information? Do they want to know all the big picture and just let them know if they need to make a major decision today or do they want to know every little fact? And just giving people control in a situation where they don't have control is really, really.


Daphna Yasova Barbeau, MD (she/her) (14:15.233)

Mm-hmm.


Terri Major-Kincade (14:41.213)

empowering and stays with families a long time. Sitting down, sitting down, sitting down. So for the learners, we know that there was lots of research that shows even if you stood up and talked to them for 15 minutes versus somebody who sat down and talked to them for five minutes, they still felt like the person who spent only five minutes with them was more empathic toward them and actually spent more time with them and they process better. Even if you actually talked to them longer, you were standing up talking.


down to them. So sitting down, using their name, asking for permission to share information, asking them what works best for them. Those things go a really, really long way, especially when you have to have a difficult conversation.


Ben Courchia MD (15:25.298)

I had an attending who said, not only sit down, find the most comfortable chair you can, because they will think, I was like, that is so good. And he says, because if you pick the most comfortable chair, they are gonna feel like you're not leaving anytime soon, you're here to chat. And I was like, this is awesome. So now, yeah, every time now I go and I pull the, almost like the breastfeeding chair, even if it's uncomfortable, I just make myself comfortable. I love that.


Daphna Yasova Barbeau, MD (she/her) (15:30.151)

Mm.


Terri Major-Kincade (15:31.133)

YEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE END


Yes!


Terri Major-Kincade (15:43.803)

I love it. I agree.


Daphna Yasova Barbeau, MD (she/her) (15:49.902)

Yeah.


Terri Major-Kincade (15:51.865)

Yes.


Ben Courchia MD (15:53.938)

Terri, I was reading your book, I was reading your blog post, and there seems that you have an aptitude that not too many of us have. You seem very comfortable in all phases of life in the NICU. It feels to me that you're comfortable prenatally, during the NICU stay, and even sometimes after. It's interesting because for most of us, I always feel like some of us are very good at one and...


maybe uncomfortable, I'm not going to say not good, but uncomfortable with another. How did you develop this, this skill of, of being in your element in all these three different phases?


Terri Major-Kincade (16:34.261)

and pros.


Daphna Yasova Barbeau, MD (she/her) (16:35.416)

Uh oh. Ben froze.


Ben Courchia MD (16:37.206)

Sorry, sorry. I'm gonna say that. My question is, how did you develop this comfort level in all three aspects of care? Prenatally, during the NICU stay, and even sometimes when either the baby is ready to go home, but also sometimes if the baby needs a palliative care physician.


Terri Major-Kincade (16:38.53)

Okay, let's feel love.


Terri Major-Kincade (16:58.533)

I'm laughing because I'm quite sure if you go back to some of my friends from fellowship, they would say she wasn't comfortable at the ECMO pump. I would say this is true. It's still very true. And anybody who has been in a delivery room would say she doesn't like blood. She's not comfortable in the delivery room. So normally if I'm at a delivery, I am at the warmer with my back to the mom waiting for the baby. And people will be, is the neonatologist here? Is the neonatologist here? Oh, it's Kinkei. Yeah, she's over there by the warmers.


Daphna Yasova Barbeau, MD (she/her) (17:21.383)

Mm-hmm.


Ben Courchia MD (17:26.829)

I'm out.


Terri Major-Kincade (17:28.489)

I learned during medical school during the surgery rotation that I pass out when the blood is going through the suction, when there's suction. Just seeing it, it looks like so much. Even if you see some...


Ben Courchia MD (17:35.986)

That's quite frightening. That's not, yeah, that's not uncommon. I'm, yeah, I'm very comfortable with blood. And when they do that, it's like, ugh, I have a little rectus there. It's just not easy to watch.


Daphna Yasova Barbeau, MD (she/her) (17:36.451)

Hmm.


Terri Major-Kincade (17:47.673)

Yeah, I learned very early. The surgery, my surgery attendings when I was a med student kind of helped me like not totally flunk the rotation. So there are certainly aspects that I'm not comfortable with. So, but I love your question. So I had said earlier that I, so I knew I wanted to be a neonatologist, but my favorite part of neonatologist, people always say that's so sad. I can't imagine taking care of sick babies and I'm sure you have babies died. But as you guys know,


A significant neonatology, yes, it's taking care of babies, but neonatology is really taking care of families. Because when the babies, you know, babies just trying to breathe, like they like, dude, I'm just trying to breathe. You are taking care of the parents, the grandparents, the staff. You mean you're taking care of all. So you, neonatology requires just such a high degree of communication anyway. And I am an empath and have always enjoyed what I call meeting people at the heart.


Daphna Yasova Barbeau, MD (she/her) (18:35.847)

Mm-hmm.


Terri Major-Kincade (18:44.857)

or meeting people or sharing my spirit or soul in a way that meets people at the heart in a way that they feel safe enough to be themselves and advocate for themselves and their children. So I learned, and so for neonatology, my favorite part of neonatology is perinatal consultation. I feel for families who don't have that and who find themselves in the NICU and they don't have a voice to advocate because they didn't know what was coming.


And so in order to talk to families who are making those difficult decisions, you have to be a neonatologist So the pediatricians are not talking to the 22 23 weekers. So I am very interested in perinatal consultation So my favorite part is delivery perinatal consultation and the initial stabilization. I love putting in uac's I love UVC's I love all that in the middle all the dwindles the ups and downs the neck the residuals the desks I'm like, oh my god, call me when they get to level two


So most neonatologists don't like level two because they like the excitement. I actually feel like in many ways it's harder because you're preparing a family to take home a baby, not a patient. And that involves talking about the nipples, the pacifiers, the sleep, the stuff that doesn't involve procedures. So I have always enjoyed spending the time with families. And then for the difficult conversations,


I learned very early that I was comfortable sitting in silence with families. For many physicians, it's hard to sit in silence. If it's more than 10 seconds, we will fill the family meeting with more words, more tests, more summary, more follow-up. But just being comfortable to sit in silence, I'm comfortable with that. And then during fellowship, whenever there would be a difficult case or a very emotional family, people would literally say,


somebody needs to talk to this family, but Terri will be on call tonight. She can talk to them. Like you've been here all day. What is happening? You have literally been taking this picture all day. I know, but you're so good at it. I'm like, y'all are crazy. So I had multiple opportunities to hone that skill and enjoy that. So I see those aspects that you described as really the aspects that involve being comfortable sitting in discomfort.


Terri Major-Kincade (21:09.357)

embracing silence and partnering with families. The technical aspects of neonatology beyond intubating, putting in lines and chest tubes, then I'm not very good at those. But I love putting in chest tubes. It's my favorite procedure. And it's very really gratifying. And then I love intubating and putting in lines. But the rest of it, like they had three ECMOs running yesterday. I was like, oh, I'm glad I'm on the palliative care side because y'all are doing like way too much. But level two, I love it.


Daphna Yasova Barbeau, MD (she/her) (21:09.608)

Mm-hmm.


Ben Courchia MD (21:38.829)

I'm laughing because we do this all the time. I feel like Daphna leaves the vents for me to take care of at night, and I leave the conversations for her at night as well. So I feel like we're both very much...


Terri Major-Kincade (21:47.453)

This! Right, we know each other's strengths, and we need the whole team, right? We need the whole team.


Daphna Yasova Barbeau, MD (she/her) (21:49.416)

Thanks for watching!


Daphna Yasova Barbeau, MD (she/her) (21:53.104)

That's right. Yeah. Absolutely.


Ben Courchia MD (21:55.026)

Yeah, absolutely. So I wanted to follow up on this, if that's okay, Daphna. It's interesting that you have this role, right, as you're a nationally renowned palliative care physician. And I see in your book a theme and in your blog post, a theme that comes back very often, something you call the gift of hope. And I thought it was kind of peculiar that the palliative care physician is so...


Terri Major-Kincade (22:16.562)

Yeah.


Ben Courchia MD (22:22.742)

concerned with the gift of hope, because I'm thinking what kind of hope is there if you're a palliative care physician? It's not, it's kind of bleak. Can you tell us a little bit where is there still hope in that context?


Terri Major-Kincade (22:35.165)

Oh my gosh, I love this question so much. So, and it's something that I hear a lot too. When people heard I was gonna do, switch to palliative care full-time, people were horrified and sending me blessings and praying for me, because I cry very easily. So people were like, oh my gosh, how is she gonna make it? So I would say palliative care, most people associate with adult hospice and palliative care.


Most people if they have had any exposure to palliative care was in the adult setting. In the adult setting, people usually come to palliative care and hospice within three, usually within two to three weeks of dying. Most patients die within two to three weeks that are adult dying. So most people, their remembrance of the palliative care team or the hospice team is when their grandfather, their grandmother, their parent had a hospice provider at the end of life.


And so I think the important thing to remember is that for palliative medicine, that it has eight domains. There are eight domains and two of those, only two of them have to do with end of life care and pain and symptom management, death and dying. The rest of the domains of palliative care are psychosocial support, emotional support, spiritual support, structure and process of care, and cultural considerations.


because all of those things are important when you're navigating serious illness. And they are often the domains we neglect in decision-making. So often when I'm called to help a family with goals of care, everybody's focusing on, they wanna get the DNR, they wanna get the DNR. But nobody has explored what the family's barriers are to imagining a different path for their child. We recently had a situation where they...


Daphna Yasova Barbeau, MD (she/her) (24:13.281)

Mm-hmm.


Terri Major-Kincade (24:22.309)

the team really felt like a baby needed a G-tube trach and they couldn't understand what the barrier was to that. The family had some psychosocial and emotional barriers because they had a family member who was an adult who had a very traumatic experience with a trach. Obviously very different from a baby, but we have to go beyond why is someone saying no. So for me, the gift of hope is when I leave a room with a family, the biggest, I got an email from a mom last week whose child probably has something that they will not survive, but.


Daphna Yasova Barbeau, MD (she/her) (24:34.876)

Hmm.


Terri Major-Kincade (24:51.185)

The best thing I can do is leave a room where I enter a room where someone thought they were in a situation with no choices. They have been presented a diagnosis and they have no choices. And they sit down with our team and they actually find out, I actually do have choices for how my child is gonna experience life for the time they are here. So what is that gonna look like? I cannot change this diagnosis, but if you haven't been able to hold your child, if you want your child to meet the siblings, if you want your child to have a baptism, if every...


Daphna Yasova Barbeau, MD (she/her) (24:57.852)

Mm-hmm.


Terri Major-Kincade (25:19.921)

child in your family has worn this gown. We can do that. If you want your child to experience sunlight, if you have a dress, I mean, people have the most amazing requests. We recently had a mom who, she had twins and one of the babies had died in utero and they asked us about cremation for the placenta because the baby that died in utero had been absorbed. No one had ever asked me that and I actually didn't even know it was a thing. But I learned that it is a thing and I learned that I could give that to them. So.


Daphna Yasova Barbeau, MD (she/her) (25:24.22)

Mm-hmm.


Terri Major-Kincade (25:48.465)

When I say the gift of hope is giving somebody choices at the bleakest time of their life at a time when they thought they didn't have choices. So we may not be able to get this, but what else are you hoping for? And so when I'm talking to learners, they often say, or even attendings, I mean, colleagues will say, well, I didn't wanna have that conversation because I don't wanna take away their hope. And one thing I really wish that we as...


Daphna Yasova Barbeau, MD (she/her) (26:10.958)

Hmm.


Terri Major-Kincade (26:14.821)

physicians, colleagues can model for our learners is increase our own understanding of the hope literature. And if you look at the hope literature for parents who are bereaved, at any given time, or parents with children who have life-limiting illness, at any given time, parents are holding seven hopes. So just a simple question, what else are you hoping for? What else are you hoping for? I know we're hoping that we can cure this disease. I know we're hoping that this nitric works.


Daphna Yasova Barbeau, MD (she/her) (26:34.911)

Mm-hmm.


Terri Major-Kincade (26:44.153)

I know we're hoping that we can get off this oscillator, but what else are you hoping for? They may say, I'm hoping I can get the hope of my baby today. I'm hoping that they will like, her little brother really wants to meet her. I'm hoping that we can do that. I'm hoping that I can get a picture with my dad and my baby. So what else are they hoping for that we can fix? And so when I say the gift of hope, it is defined by the family, realizing that they have choices where they...


Daphna Yasova Barbeau, MD (she/her) (26:50.92)

Mm-hmm.


Terri Major-Kincade (27:10.673)

previously didn't have choices. And so that domain of structure and process of care, we in the NICU all have rules that work because we need to do our job. Like we have rules, we need to do our job. And a lot of our rules cause families significant emotional distress. Like NICUs that still have said visitation hours, NICUs that don't allow any siblings to visit of any age. One of the things, and I'll go to your next question. One of the things that was,


Daphna Yasova Barbeau, MD (she/her) (27:27.748)

Mm-hmm.


Terri Major-Kincade (27:39.697)

really beautiful for me when I first transitioned into private practice was we learned from a mom. We had a baby that died of neck like Christmas Eve and the mom had a son who was three. And the NICU at that time had a visitation policy for five and up, for five and up. And so at the funeral, at the funeral, the mom said, you guys provided amazing care to my baby. You know, you gave my baby every chance, but one thing I wish you would do differently.


as have allowed my son to meet his sister before she was dead. And so as a result of that, that Niki started doing something called Sibling Sundays. And so on Sibling Sundays from 6 to 8, any sibling who didn't have a fever could come in and visit. And so palliative care, yes, we deal with end of life. And when I'm introducing myself to families, we tell them we're part of the palliative care team. And we are here to provide support for the journey.


Daphna Yasova Barbeau, MD (she/her) (28:12.542)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (28:25.855)

Hmm-hmm.


Terri Major-Kincade (28:38.265)

and that support looks different for different families. And the way we learn how to support you is we get to know you. So this is an opportunity for us to get to know your family, know what's important to your family, see how we can support you. And for some families, that is having difficult conversations for the end of life. But for many of our families is navigating the journey, all the ups and downs that are associated with this diagnosis. How can we help you today?


Daphna Yasova Barbeau, MD (she/her) (29:01.896)

that I think if people only take away one thing from our whole conversation, I think your discussion on navigating hope is absolutely critical to us giving families what they need and the opportunity to tell us what they need. You spoke about a physician who said, you know, I don't want to take away a patient's family's hope. In my experience, I've encountered the opposite. That they're worried.


Terri Major-Kincade (29:20.179)

Yes.


Daphna Yasova Barbeau, MD (she/her) (29:30.588)

that they don't want to give too much hope to a grim situation. So give us some tips about managing, balancing, still being hopeful while also being realistic with families, which is something that we can do.


Terri Major-Kincade (29:47.525)

Yes. So you're right, it's one of either extreme. People feel like their colleague may not be, they're not being realistic enough. They gave the family too much hope. Other families or other colleagues saying, I don't really wanna have that conversation because I don't wanna take away their hope. They're really fragile. I don't wanna take away their hope. And so I would challenge, this is something I do a lecture with our nursing staff about.


Families actually know more than they have shared with us at the bedside. People learn coping mechanisms in the NICU as they're navigating the journey. And I've had families say to me, moms who've had 22, 23 weekers, who people say, don't they realize they have a 22-weeker? Like they come in here every day smiling, and don't they realize that this is not? And I've had moms say,


Yes, I know that this is scary. Like anybody who has a child in October whose child was not due to February does not need to come in here and tell me, hey, this is really bad. They know, they know they don't need, but they have to protect that part of themselves so that they can navigate the journey. Alternatively, if they come in every day crying, what do we do? We call social work, because this mom's crying all the time. She's not coping well at all. Then she needs to go talk to somebody. I am worried. So if they're not realistic enough, we're worried. If they're crying too much, we're worried.


Daphna Yasova Barbeau, MD (she/her) (31:05.946)

They can't win.


Terri Major-Kincade (31:11.405)

So what do we want? So one of the things I would say in order to approach families who you do wanna have maybe a deeper conversation about some choices that may need to come up, you can literally say, when the family is saying, I'm just hoping that this works out or I'm hoping that the ventilator works, you can say, I'm hoping for the same. Can I share with you a worry that I have? You can say, I'm hoping for the same. I'm hoping for the same.


We were in a family meeting yesterday and the dad said, I know you guys think that my daughter has something that she cannot survive, but we are hoping that she leaves this hospital alive. And the surgeon said, we are hoping for the same. Like it was just so wonderful to kind of align very early at the beginning of the meeting, which allowed us later to say, we're hoping for the same. Can we share with you some worries we have? One worry that we have is in order to.


meet that milestone, she may require this or she may require that. And, you know, how does your family feel about that? You know, having additional technology for us to meet that. So I usually explain to the learners as wishes, hopes and worries. So I wish we didn't have to have this conversation. I'm hoping for the same. Can I share with you a worry that I have and just saying, can I share with you as opposed to, look, we need to talk. The son is not good. The echo is not good.


our recommendation is to stop with no emotional empathy. So we have to weave in the emotional IQ with those conversations to layer the hope. And actually, clear, compassionate communication, if it's clear, compassionate communication, you will never take away a family's hope. Families will come back to you later and say, that was such a hard conversation, but I'm so glad that you guys had it with us because it allowed us to reframe what we're hoping for. So.


We may not be getting home, but what I'm hoping for now is that my mom can meet her first grandchild. So by having that conversation, you allow people to reframe and you can still carry hope. They don't leave the hope. They still are hoping for that. But within that hope, they have a bunch of other hopes. So I wish this wasn't the case. I am hoping for the same. Can I share with you a worry that I have? And then share your worry.


Daphna Yasova Barbeau, MD (she/her) (33:36.036)

I love that tip. You know, since we're talking so much about palliative care, you obviously have gotten the additional training for palliative care. Now you're the director of pediatric palliative care. It's my sense that neonatologists in general over the decades feel like we're pretty good at having conversations about hard topics and death and dying.


I'm not sure families experience it in that way. Can you talk a little bit about why, even though you may be an empathic person and you may be a very good physician, that the palliative care training offers something that our other training doesn't and why we need more palliative care professionals in the NICU?


Terri Major-Kincade (34:25.989)

Yeah, I love that question. And even when you guys introduced me, I was just smiling because I went into the pediatric palliative care program solely because I wanted to get skills for talking to bigger kids. I went into the program thinking, okay, I've been doing it 22, 23 years. And yes, I know how to talk to parents and people tell me that I'm good at this. And I've...


I've written a chapter so I must know something about it. But I mean, I went into it very open because it had been a long time since I talked to a patient who could talk back to me. And it ended and it was just such, it's just the gift that keeps giving. I would not advise anybody else to go back to fellowship at 53 because I mean, that's a whole nother podcast interview we could talk about later. But what I can say is two key things. When we do our neonatology fellowships,


How do we learn how to put in umbilical lines? How do we learn how to intubate? How do we learn how to put in the chest tube? We learn by doing. They are procedures that had to be learned and mastered. And so palliative care, your procedure is communication. Our procedure is communication. Most of us learn communication by watching our attending and like, oh, I don't wanna do that. Okay, maybe I'll do that. I don't wanna do that. Okay, I might do that.


Daphna Yasova Barbeau, MD (she/her) (35:49.397)

That's right.


Terri Major-Kincade (35:49.925)

This family got mad at me. Not going to say that again. OK, this family liked me. I think I'll try that again. I mean, we all have kind of formulated a way to kind of do it. And now in neonatology fellowship training, they have simulations and Ossies around difficult conversations. But those of us who've been doing it a while, you just kind of learn by doing it, and we stung it along the way. Communication is a procedure.


And there are specific ways to learn how to navigate these conversations with colleagues, with patients, with parents. And so the gift for me for that whole year was that I learned procedural approach to communication. And I definitely learned some tips that were not in my arsenal. And I learned some pitfalls for some of the ways I communicate, just like asking for permission, the wish is hopes worry, using more empathy. I was doing that anyway because I'm an


a empathic person, but it's a procedure. And so if you have not had formal training in communication, you may be great at it. But I can tell you, it helped even the communication. I've been married almost 30 years. I was using those communication tips. Go, my husband was like, this is great. Because I'm like, is this an okay time to talk? You know, and so he's like, yay. And so, and then even diffusing conflict.


Daphna Yasova Barbeau, MD (she/her) (37:00.958)

Mm-hmm, mm-hmm.


Terri Major-Kincade (37:10.669)

If parents are saying something and you feel like they're just not getting it, instead of repeating data over and over and over using the sentence, can you help me understand how you guys are processing this? Or can you help me understand how you came to the decision that this would be best for your daughter? Or even if you're in an interdisciplinary meeting and the surgeon or the nephrologist or the cardiologist is making a recommendation different than what you thought your patient may have needed, you can say.


Great, I'm so glad you're here. Can you help me understand the steps that would be necessary for this test? Okay, great, now I got it, thank you so much. So just saying help me understand is great. So those tips were great, but when I first started fellowship, every time we went into a room, my attendees would be like, what would you do if you were in this situation? I'm like, I'm here to learn, I'm here to learn. Because you know, a very senior fellow.


Daphna Yasova Barbeau, MD (she/her) (37:59.568)

Hehehehehe


Terri Major-Kincade (38:03.869)

was older than most of my attendance. But so they were not expecting me to be fully immersed as a learner, because I kept saying. And for me, for the big patients, the hemoc patients, when they are telling you that they don't feel well or that they're in pain, and you say you're going to do something for their pain, and you come back the next day and you go, how's your pain? They go, my pain is still here, you suck. I'm like, okay, I'm going back to the nephew, because I'm not. So I did not have any


Daphna Yasova Barbeau, MD (she/her) (38:27.432)

Mmm. Mmm-hmm-hmm-hmm.


Terri Major-Kincade (38:33.657)

bandwidth at all for talking to young adults about their pain, about death and dying, about how they want to die, about their choices. And Ben asked me earlier about fragility. I would say the hardest, I have a son who has some learning challenges, he's a neurodivergent, and I would say the hardest part for the bigger kids for me, the kids that were 20, 21, 22, 23, that were close to the age of my children.


The hardest part of last year was talking to those kids about what was important to them, their choices for how they wanna manage their suffering if they wanna die at home or in the hospital. I didn't have any frame, I had no framework for that. I could have conversations like that in the NICU all day, but those were the hardest parts of the year for me. And I learned something about myself in terms of my triggers and my vulnerability, because it's really related to what seasons of life you're in, so.


It was an amazing year, but communication is a procedure. So I think most neonatologists think they do it well. And most neonatologists, even if they have a palliative care team, they only call a palliative care team at end of life for the baptism. I think if we could just call them earlier so families can have somebody to partner for the journey for the psychosocial and emotional part, it really helps with team distress and it definitely helps the families.


Ben Courchia MD (40:02.538)

Terri, I wanted to know if maybe we could switch gears from this discussion, because what we're gathering on top of everything you're telling us is that you're such a passionate individual about what you do and how you do the work in the NICU. In your book, Full Circle Moments, you do talk about this, where this passion really drives you to take so many things on in the NICU, and that sometimes it can be hard to balance this passion with...


with your other passion, which is your family. How, how, what is your advice for people like us? I think we are all on this podcast. And I think for many of our listeners, we're truly passionate about the work we do in the NICU. How do we balance, uh, work and, and home.


Terri Major-Kincade (40:49.908)

Um...


say don't do what I did.


first thing I'll say because this work is all consuming and it's very easy to take it home and so very early in my career because of my passion for neonatology, the work was all consuming. I spent more time at work by choice than with my husband and my kids and it took a while for me to realize that yes I love this job but this job is not my whole identity. This job is not my whole identity.


And so I had to leave academia and come back to rediscover who I am, what's important to me, and how to prioritize that. So one thing I would say for us as we're modeling, especially for our learners, this is another thing I learned last year during the Palliative Care Fellowship, because obviously it's very different than a NICU fellowship. I went in thinking it was gonna be like a NICU fellowship, like I was worried about call, I had just had a hip replacement, I'm like, I have my hip, I have my cane, they're like, it's Palliative Care, nobody's running.


Like, it's fine, you're gonna be fine, Terri, like calm down. But I was very concerned, but just stopping to eat lunch and go to the restroom. I was like, y'all saw three patients, what do you mean you're gonna eat? Like, what are we, like we have 10 people on this list. Who's eating, like what is wrong? Like you people are, what is happening? And then we would see a patient and they would encourage a bio break. And I'm like, what? Y'all are actually gonna take care of your bladders? Like, who does that? I'm pretty sure my bladder got a neglect. The entire-


Daphna Yasova Barbeau, MD (she/her) (42:05.916)

Hehehe


Daphna Yasova Barbeau, MD (she/her) (42:17.956)

Yeah, they're much more in tune with their self-compassion, aren't they?


Terri Major-Kincade (42:22.237)

Exactly, but in doing my fellowship, I'm quite sure I held it for three years. So one thing I took from that now when I have learners, my first week of learners back in academia, I have my Friday debriefs. Every Friday somebody said this is the first time I actually got to sit down and have lunch. This is the first time I actually got to, somebody actually asked me, you know, instead of, you know, doing lunch while they were doing their notes, which we model, and so then they do that. So I would say a couple of things is


Daphna Yasova Barbeau, MD (she/her) (42:27.328)

Hehehe


Terri Major-Kincade (42:51.509)

figure out what your North story is and what's what you're most passionate about and figure out how to make your job fit into your life and not your life fit into your job and I would say the first Five years of my career I was really trying to figure out how to make my life fit into my job and when we're trying to make our life Fit into our job. That's when we have burnt out And we stay on the hamster wheel and we look for more and more ways to be more and more productive


and in those ways don't usually prioritize the family or life or whatever you do when you're not at the hospital. And so just figure out what's most important to you. And when you look at that, how does your job fit into your life? And so the job I have now fits into my life. The job that I had 2000, 2004, my life was fitting into my job. And that was hard. My kids were in a 24 hour daycare.


I would go in on the weekends even when I was off because I felt like the families needed to see me. And of course my colleagues were like, if her crazy self wants to come in on the weekend. It's great, we don't wanna go. Cause I had a chronic pie with all the G-tube trick shop babies so people were happy to let me come in around on my own patients. And I would also say to those of you who do have work like balance, if you see your colleagues making choices that are not that.


Daphna Yasova Barbeau, MD (she/her) (43:57.318)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (44:06.44)

Mm-hmm.


Terri Major-Kincade (44:16.861)

We need to stop normalizing that behavior. We need to stop rewarding the behavior. People were rewarding me for coming in when I wasn't supposed to work. And so I got an award for physician of the year and they literally were saying, Dr. King-K is great, she comes in on the weekend even when she's off. And my husband was like, you told me you had to work. Like he's sitting there looking at me like, I thought you had to work. So we should not normalize these toxic.


Ben Courchia MD (44:37.238)

You've been ousted.


Terri Major-Kincade (44:41.817)

behaviors. So, and we want to model that for our learners. A lot of the learners are coming in now very clear that I love medicine, but there are other things that I want to do. And I really envy that, you know, like we're like, yay, but secretly we're like, well, I didn't get to do that. Why do you get to do that? So they're really clear. So make sure your job, whatever you're doing is fitting into your life and you're not trying to make your life fitting to your job. And then do not normalize


Daphna Yasova Barbeau, MD (she/her) (44:52.584)

Mm-hmm.


Yeah.


Terri Major-Kincade (45:11.153)

patterns. You know, people, when people are off, they should be off and we have to take care of ourselves if we want to take care of patients. So why do we think we can take care of patients if we're hungry, hangry, hypoglycemic? We cannot. So, but we do, but we cannot. So.


Daphna Yasova Barbeau, MD (she/her) (45:21.832)

Hmm.


Daphna Yasova Barbeau, MD (she/her) (45:26.416)

Yeah, I love that.


Ben Courchia MD (45:27.306)

I wanted to then just touch on one more point before we get to the last phase of this interview. But in the book, you talk about, I think there's a chapter called, Do As I Say Not As I Do, where you find yourself conflicted with now the reality of having a child at home. And some of the things that we do tell parents at the bedside, like you mentioned, like your baby having colic. And like, I could totally see myself there where we tell parents like, oh yeah, that's not proven to work. But then when you're the one with the screaming baby, like...


Terri Major-Kincade (45:40.152)

Yep.


Ben Courchia MD (45:56.034)

Can you tell us a little bit about that, how that's a little bit of a maturation that you reach at that stage?


Terri Major-Kincade (45:59.025)

guys.


Terri Major-Kincade (46:04.021)

Yeah, it's so interesting for, especially for those of us who started our career before we're parents and now we are parents. Two examples that I think of immediately are like, for example, crying, like Ben mentioned, crying babies. So, you know, very early in my career, I'm saying, babies cry, babies cry. That's how they communicate with us. Babies cry, babies cry. And, you know, and then my son had horrible, horrible colic. I was already faculty for neonatology. I took him


Daphna Yasova Barbeau, MD (she/her) (46:09.768)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (46:30.359)

Mm-hmm.


Terri Major-Kincade (46:32.845)

I know he has interception. Y'all need to find a hair tourniquet or do something. I mean, I ultimately ended up sending him to stay with my mom for six weeks. And people were like, how's your baby? I'm like, I have one child or daughter. Like, this is like, I'm done. And so she kept him and she's like, it was just your breast milk, you know, whatever. So I was like, okay, fine. It was lactose intolerant. But the amount of distress I had with a crying child and I wanted to go and find every mom I had said that babies just cry and for breastfeeding as well.


The amount of, I started talking about breast, you know, importance of breast milk and pumping, and before I had gone through that experience, and those first three to five days while you're waiting for the milk to come in, that is a very stressful time. And it's a time when a lot of people stop. And I was one of those people who were like, you can do it, go for it. And so I went through that with my first child. But my second child, I was like, I'll see him in two weeks. You know, I was pumping up, I was like, I'm not gonna do it to myself.


Daphna Yasova Barbeau, MD (she/her) (47:02.307)

Hmm. Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (47:25.736)

Hehehe


Terri Major-Kincade (47:29.613)

My kids were in, our daughter was in our bed till she was three. We know we're not supposed to do co-sleeping. Know we're not supposed to, but you know, she was in there. And the only reason she got out was because one day my husband came home from work and woke her up and she was crying because she took his pillow. And I was like, you took her pillow. He's like, you know what? It's my pillow. She needs to, she's gone. And so that is how she got out of our bed. And our son like never got in our bed. So.


I do think, yes, we need to make the recommendations. I kept my nieces, they watch a lot of Disney videos. We tell people no screen time before age three. I mean, like, who can survive that? Like, I don't think anybody can. So it's just anybody with multiple small kids. So I think we have to make recommendations and we need to let parents know why we're making the recommendations, but we have to give people space to kind of navigate what works for their family, what makes sense for their family.


Daphna Yasova Barbeau, MD (she/her) (48:00.936)

Hmm.


Daphna Yasova Barbeau, MD (she/her) (48:07.037)

Hehehe.


Daphna Yasova Barbeau, MD (she/her) (48:19.784)

Mm-hmm.


I don't know.


Terri Major-Kincade (48:23.909)

Because at the end of the day, they have to do what works and makes sense for their family, which may be very different for what works and made sense in my.


Daphna Yasova Barbeau, MD (she/her) (48:32.336)

I love that. And, and parenting is changing, right? Society is, is changing. Yeah, that's right. I'm still regrouping a little bit because when you were giving us this discussion about work-life balance, you were speaking directly to me. Uh, Beth is probably going to nod and chuckle cause he, he knows how much I struggle, I struggle with it. Um, but I, I think that's, I think that's what's so powerful about the way that you speak. I think you have been.


Terri Major-Kincade (48:36.345)

Yeah, I think you're still in the room.


Terri Major-Kincade (48:48.325)

Yeah, it's like out, right?


It's like house.


Daphna Yasova Barbeau, MD (she/her) (49:01.828)

I'm unapologetic and unafraid to say things that needed to be said about life and medicine and our community and medicine. And so I'm hoping you'll address some of the other things you've spoken about, some of these other barriers and obstacles, like being a woman in medicine, being a Black physician. You know, I have loved hearing you speak about that. So I hope you'll give us even just a little bit of that today.


Terri Major-Kincade (49:32.773)

Okay, is that, oh, am I talking about it now? Is it a question? Okay, all right. So, I love you guys. Yeah, I love this work-life balance question. And before I answer that, I'll say the other thing I hope that we can model for ourselves and our learners is that we can have all the things, we just can't have all the things at the same time and we can say no.


Daphna Yasova Barbeau, MD (she/her) (49:36.048)

Yeah.


Terri Major-Kincade (49:58.277)

We can say no to opportunities that are intellectually stimulating, may be fun, but we don't have time. And if we're saying yes to something, we need to be saying no to something else. And so just getting in the habit of, yes, I'd love to partner with that at another time. I don't have time right now. Or no, I don't think at this time I can participate in that because very early in my career, I was a very yes, yes. So I would say with respect to being a woman in medicine,


What I really like about, so I've returned to academia after 22 years to the place where I trained before for neonatology. But when I was in neonatology before, there were not many women in the department of pedes and there weren't many women in the department of pedes who have families. And so I was, people had basically the school, the university, their career was their family. Their career was their family. They had made the decision very early on that this is gonna be, and that's fine.


Daphna Yasova Barbeau, MD (she/her) (50:46.056)

Bye.


Daphna Yasova Barbeau, MD (she/her) (50:51.772)

Hmm.


Terri Major-Kincade (50:56.781)

if that's the path you've chosen. But for me, I didn't have role models for people who were married with children. So all my role models were people who were there all the time or people who had partners who maybe stayed at home with their kids. And so I was trying to keep up with that as well as trying to be a wife and a mom. Something that was really, one of the things that really, that happened right before I left was


I remember getting ready for a PAS project. I had a presentation at PAS. I love my mentor. I have followed him from residency to Houston. He's a really big wig in neonatology. He still is. He's like a great grandfather in neonatology. I won't say his name now, but I have followed him there. And I'll never forget, we were working on this PAS project. My kids were already in a 24 hour daycare that everybody had said was okay.


I was already begging people, can I leave to go to my kids birthday party? Nobody else was asking to go to a birthday party. So feeling, you know, as a woman, that I wasn't equal to people who weren't having to make these weak requests. But I'll never forget, I was preparing for a PAS presentation and I remember, you know, it's like five o'clock, I was on, I had just gotten off service. And I said, hey, I gotta go pick my kid up from daycare.


And he's like, but we need to finish this. Like we need to finish it today. I'm like, okay, well, can I go get her and come back? So my daughter was like nine months. So I went and go pick up my daughter and brought her back to the medical school. We're like sitting in my advisor's office and I'll never forget, he was going over slides and data and my daughter still had a pacifier in and she literally took the pacifier out and just threw it at him like, both of these people are crazy. Like it is seven o'clock and nobody cares about these graphs. You know what I mean? So I was like.


Ben Courchia MD (52:37.71)

Thanks for watching!


Daphna Yasova Barbeau, MD (she/her) (52:40.264)

Hmm.


Terri Major-Kincade (52:45.073)

this child is the only one in here, like, why are we doing? She was the only one who was like, no people like this is not okay. So what I would say, what I really like about B, I know that there are still challenges and I know that even if people have initiatives, there's that hidden curriculum in medicine that you have in academia that you have to navigate to be at the table, to be invited to make the discussions.


Daphna Yasova Barbeau, MD (she/her) (52:46.151)

She was done. She was done with this.


Terri Major-Kincade (53:10.965)

to be impactful in your career, to be seen as having value. But what I will say is, I do think the tide is changing. When I first joined this job, there was a Grand Rounds on how to support learners who have children, how to support learners who have children. And I remember thinking, where was this Grand Rounds in 98? Like, I don't know.


I was happy for the learners with children, but I was like really that's what we so it's just so and it was just very a very trauma informed approach a very authentic approach to One size does not fit all yes We there we're all here to learn and contribute but one size does not fit all and people need different things to be successful and we should be able to


meet people who have different challenges. Not change our total curriculum, but we shouldn't be so inflexible because what happens is people leave. And we don't want everybody to leave. We want those brilliant minds to be there. So for me, I will say very early on, the biggest challenges I had were trying to find space for the things that were important to me as a parent, a wife and a mother, and navigate academia. The second thing I'll say that was really hard for me is I had somebody, I had a...


my medical director or boss, write on one of my evaluations. Terri is great with the patients. She's great with the families. Everybody likes working with her. However, she does not come to journal clubs at college styles, you know, for bonding at the journal clubs at individual, when we have journal clubs outside of work, she never participates in those. And participation in these activities is really important for the team, you know, for the team dynamic.


Daphna Yasova Barbeau, MD (she/her) (54:43.247)

Uh.


Daphna Yasova Barbeau, MD (she/her) (54:46.671)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (54:51.93)

Hmm.


Terri Major-Kincade (54:57.881)

And so I thought, would you write this on anybody else's job evaluation? She does a great job. She takes care of patients. The nurses like her. The colleagues like her. But she won't come to our house for dinner for Journal Club. I mean, that is something we could have had a conversation about, but to be a formal part of my recommendation. I don't feel like that's something that would have been written for someone else. And the last thing I'll say is about the pay disparity for women in neonatology. There is not a lot of transparency in salaries and medicine.


Daphna Yasova Barbeau, MD (she/her) (55:04.261)

Mm-hmm.


Terri Major-Kincade (55:27.521)

a lot of places have clauses that don't allow for transparency. But something that really was very impactful for me when I left academia the first time is one of my former fellows was at the practice I was joining. And he's a Caucasian male, an amazing guy. And he said to me, Terri, if you take this job, do not take one penny less than this.


Daphna Yasova Barbeau, MD (she/her) (55:54.184)

Hmm.


Terri Major-Kincade (55:54.245)

He's like, this is what I'm making and this is what you should make. And my first offer was 50K less than what he told me not to take. And if he had not said that to me, I would have taken it because even though it was 50K less, it was a lot more than academia. And so, but he took the time to say that to me and it allowed me, it supported me, it put me at equal bargaining, equal footing for bargaining. And then when the practice went through a change three years later for salary increases,


Daphna Yasova Barbeau, MD (she/her) (55:58.125)

Hmm.


Daphna Yasova Barbeau, MD (she/her) (56:02.804)

Wow.


Daphna Yasova Barbeau, MD (she/her) (56:09.109)

Mm-hmm.


Daphna Yasova Barbeau, MD (she/her) (56:12.761)

Yeah, supported you. Yeah.


Terri Major-Kincade (56:24.397)

I was where everybody else was, so I was able to get the same, whereas people who had come in lower, their incomes were still less than what people were making. So I think normal life, we need to be candid about pay disparities in neonatology, disparities with respect to promotion, tenure, the way work-life balance impacts, the way people navigate their career track. Now, having said that,


Daphna Yasova Barbeau, MD (she/her) (56:27.56)

Mm-hmm.


Terri Major-Kincade (56:51.733)

at least a lot of places I've looked at now have a lot of different career tracks that allow people a lot more flexibility, a lot of hybrid career tracks. And I think that that's amazing. So I will say that's what I'll say about my journey. What I'll say about being a black physician is one of the things that was really important to me early in my career, and is still very important to me, is the use of stigmatizing language and the way some providers


temper their treatment recommendations based on their perception of a family. So ideally, if we have clear treatment recommendations that are evidence-based, we should be presenting the same recommendations to every family. But there are some people who feel that some families can't handle X, Y, Z, so they just offer X. And there are other people who offer different things. So that was very important to me early in my career, the way our biases impact the way we make treatment recommendations. Deliver.


treatment recommendations, especially in perinatal counseling. But in the 80s, in the 90s, nobody was doing that kind of research. Nobody was on that kind of research, communication research, qualitative research around the way our physician communication impacts parent decision-making and how parents felt about it. But now everybody's doing it, especially since COVID. There's a lot of research looking at stigmatizing language in the medical record, the way we describe.


certain populations as difficult or angry, the way we get safety plans on certain populations, the way we decide who can get a trach and who can't, the way we have rules about two patients, two providers have to learn how to care for the trach and a family that doesn't have two providers, but they have their main provider because the other person's working all the time. So that stuff has always been really important to me. And I do feel like early in my career, there wasn't a space for me to explore


scientifically to things that were really, really important to me and my core. And now a lot of that stuff is happening. So I think that, I think the conversations around diversity, inclusion, different family models, all of that has been really, really exciting just to make sure that we are doing the best we can to empower all families to make the best decision for their child in their family dynamic.


Daphna Yasova Barbeau, MD (she/her) (59:14.421)

I'm hoping you can speak a little bit to also, certainly some of the minoritized populations are overrepresented in the NICU and underrepresented in our NICU staff. Why is it important that we fix that imbalance?


Terri Major-Kincade (59:26.351)

Uh huh.


Terri Major-Kincade (59:37.105)

So, um.


I know that you guys are familiar with the study that came out a couple of years ago about the patient that came out discussing racial concordance with providers, NICU providers, and babies that did, black babies that were carried by black providers did better than babies who were not cared for by a provider who was racially concordant. So that study was very controversial in almost every.


hospital I went into in every practice because people feel like once the baby's here, the baby's here. Like I'm just taking care of the baby. Like that's, I'm just taking care of the baby, which I agree with that point. But what I will say is outside of that study, we already had a lot of information in terms of perinatal health disparities in terms of patients from minoritized populations doing better when cared for by providers that look like them. And why may that be? Well,


People think of bias, but another reason why that may be is just that people feel more comfortable when they see someone who looks like them, when they see someone who speaks like them, when they see someone just looking in their eyes, they may feel more comfortable sharing a fear that they may not feel comfortable sharing with another provider. I also think in the US in particular, we have to be mindful, especially if you're dealing with a multi-generational family.


particularly a black family, multi-generational black family, you may be practicing at a hospital where they actually remember their loved one could not be treated there. They may have somebody in their home who actually died because they could not be treated at your hospital. And so now they have a baby in your hospital and you're trying to talk to them about redirecting care. And so it's very hard to pack some of the historical trauma that comes along with that. But sometimes if you see someone that looks like you, if you see someone who speaks your dialect,


Terri Major-Kincade (01:01:28.237)

If you see someone who understands your spiritual and cultural traditions, you see someone who understands why your faith is the way you're making decisions. It really does create space for you to make treatment recommendations that somebody else wants to make too. But the family didn't open up enough for them to be able to share that. So for me, when I went to medical school, I had never seen a physician of color. I knew I wanted to be a doctor, but I had never seen a black doctor.


I had never seen a black female doctor for sure. And so I know that when I go into rooms, when I speak to learners, people always come up to me and they'll say, I saw you on such and such and it made me wanna be a doctor. I saw you on such and such and I wanna be a doctor. When I'm in the hospital, at least one grandmother a week will say, baby, we're so proud of you. They're not my grandmother, but they see me as a win for everybody just by being there and they see it as a safe space. So I hope those of us who are navigating


Daphna Yasova Barbeau, MD (she/her) (01:02:17.076)

I believe that.


Terri Major-Kincade (01:02:26.865)

these environments recognized that it's not just the patients, for your colleagues, for your colleagues. In the United States, when George Floyd died and I had to go to work the next day, not one person asked me if I was okay. Not one person, not one person, not one person asked me if I was okay. I was not okay. I did go to work, but nobody asked me if I was okay. Nobody said anything. We just went on as work business as usual. So I think we just have to understand that


Daphna Yasova Barbeau, MD (she/her) (01:02:45.386)

Mm-hmm.


Ben Courchia MD (01:02:46.754)

Right.


Terri Major-Kincade (01:02:56.537)

It's not just our patients. Like there are lots of ways we find safety and community in our lives outside of work. It's where we live, where we go to church, for those of us who go to church, where we go for fun. Like we go to places and we have connections based on similarities and differences. So we have diversity, but we also have connections based on similarity. And there is a trust that can happen.


especially when you're in a vulnerable situation as a patient, when you have concordance. So I'm very passionate about speaking to pre-health students, pre-nursing students. I go back and speak to my college often. I was a lecturer this summer for the med school I work at for those students, because it's really important for us to make sure that we decrease these disparities that we have in healthcare providers across the pipeline so that we have more people on our team who can contribute to diversity, and not just racial diversity.


So, I mean, we need cultural diversity, we need spiritual diversity, we need everybody, we need people who are differently abled. I mean, like we need everybody at the table so that people feel seen, heard, and understood. Otherwise somebody is constantly having to navigate, how much do I reveal? Do I feel safe? Are they gonna use this against me if I say this? I mean, I'm always surprised when somebody's been in the NICU for several months, and I find out one thing that would have really made a difference for the team.


to make a treatment decision, but the family just didn't feel safe enough to share. Or worse, we didn't ask. Maybe they did feel safe, but we didn't ask. Is there anything else bothering you today? Is there anything else you were hoping to talk about today that we didn't talk about? I'd love to hear about it.


Daphna Yasova Barbeau, MD (she/her) (01:04:37.472)

Mm-hmm.


Ben Courchia MD (01:04:38.698)

Yeah. I think that's interesting. When that study came out, as you said, it was very controversial because I think from an innate standpoint, many of us felt like, well, I try to do my best. I do the best I can to care for patients. But we were having this discussion at home and we were thinking about this from a different perspective, a bit like if you're traveling abroad and you are needing healthcare and you suddenly find a healthcare provider that's like from your neck of the woods and you're like, oh my God, thank the Lord. Right? And it's, and it's very


Terri Major-Kincade (01:04:59.205)

Yes.


Terri Major-Kincade (01:05:05.668)

Yes! You're so happy!


Ben Courchia MD (01:05:07.698)

It's exactly right. And it's like, you feel like everything is going to be okay because my God, I found like an American doctor that was in, in this part of, uh, I don't know, Japan and now I understand what's happening. I understand what's going on. They can reframe them in my terms. So I think at the end of the day, when you realize that it's. It's exactly right. And that person.


Daphna Yasova Barbeau, MD (she/her) (01:05:08.833)

Yeah.


Terri Major-Kincade (01:05:14.073)

Yes!


Terri Major-Kincade (01:05:21.121)

Yes. And it's unspoken, right? It's unspoken. It's almost instantaneous when you see that person.


Ben Courchia MD (01:05:30.694)

It's exactly right. So I think from that standpoint, for me, at least it started making sense that it's not about, like you said, in the beginning of this interview, it's not about just the numbers, right? It's about all these other aspects of care that we're sometimes neglecting. I mean, you've given us so much throughout this interview. I guess I wanted to finish off as we're getting close to the end about how you've made an intentional point of asserting your presence.


Daphna Yasova Barbeau, MD (she/her) (01:05:40.909)

Hmm.


Terri Major-Kincade (01:05:41.435)

Right.


Ben Courchia MD (01:06:00.274)

on the internet, on sharing your message. And I'm saying this in a very positive manner, because I think that sometimes we are too, we're stuck and too attached to various institutions and we're dependent on whoever is going to allow us to say something, right? So it's like, you are dependent on when the marketing department of the hospital is willing to do a little segment and then you'll be allowed to say what you have on your mind.


are a trailblazer from that standpoint where you say, I'm going to build a platform for myself, your website, drTerrimd.com. Yes, drTerrimd.com. You're sharing your thoughts and you're giving yourself an opportunity to express yourself. How important was that for you to do this? And what is your advice for...


the students, as we said earlier, who are so special, but are being told, just conform, please. Just fall in line.


Daphna Yasova Barbeau, MD (she/her) (01:07:01.808)

Not just the students, all of us across the career spectrum, right?


Ben Courchia MD (01:07:04.746)

But I think it's ingrained in us in medical school. I mean, we were talking about this at CHNC where students were coming in saying, hey, I have a startup and you should focus on something. You should reformat your SIM card and just get in line with everything else. Can you tell us why this platform was important to you and what was the realization that said, I need to take the megaphone myself and speak for myself?


Terri Major-Kincade (01:07:04.953)

Yeah, everybody.


Terri Major-Kincade (01:07:18.693)

Right.


Terri Major-Kincade (01:07:33.713)

I love this question because I'm in a bit of a get back in line mode now because I came back to academia. But um.


So it may be a whole different podcast next year. Y'all will be like, she didn't say anything. No, I'm just joking. So, but I love this question. So I do think it's important for the audience. So from 2000 to 2004, I finished neonatology in 2000. I stayed in academia to 2004. I left for my family to have better work-life balance. And so that allowed me to be in private practice from 2004 until...


Daphna Yasova Barbeau, MD (she/her) (01:07:46.716)

They can't hold you down, Terri. They can't hold you down.


Terri Major-Kincade (01:08:16.558)

I started doing locums and I did locums for a couple of years and then I went and did the palliative care fellowship. So the first thing I would say is, as I mentioned earlier, the things that were really important to me, the things that I thought were impacting patient care, nobody was speaking those or when I would bring it up, people would be like, that's not that important, that's not that important. Or people would say they would just stick to the data.


there were other issues impacting decision-making and the way we recommended stuff to patients. So when I left academia, I was totally free in private, when I negotiated my contract in private practice, I already had decided to start Dr. Terri MD and they were like, do whatever you want, that's fine. Just don't tell people you work for us. And so I never did. And people just know I was in Texas. And then March of Dimes really allowed me my very first platform.


to talk about perinatal health disparities. So that was something that was really important to me. And then from there, they created a platform to develop a toolkit for implicit bias training for the state of Texas. And then that allowed me to go to colleges and to DC a couple of times and start speaking on a national stage. And so at the same time, I already knew the things that I had wanted to put.


in my first book. And so each opportunity just allowed me, I found that people really responded to the, like Daphne was saying, the authenticity of saying the things that are on a lot of people's minds. I did feel very free in that because I was answering to not speak my mind was actually more painful to speak my mind. And I found that it opened many doors. So fast forward to coming back to academia. So


I'm coming back to academia after already having been Dr. Cherry MD for 15 years. And even in talking about taking this job, which is my dream job, I kept saying, I still have to be Dr. Cherry MD. Like, I'm still gonna be speaking about these things. I'm gonna be talking about these things. And they said, oh, we want you to still be Dr. Cherry MD. We hope you may give us a shout out, but we're fine. So, thanks. Thank you. I said we'd like to benefit from this association as well. So.


Daphna Yasova Barbeau, MD (she/her) (01:10:21.412)

Mm-hmm. That's right. Good for you.


Terri Major-Kincade (01:10:27.925)

That ended up being in between first starting and then the partnership with Pampers helping them to rebrand their, they had a, they were rebranding all their for facing material for women of color navigating pregnancy. Like that was very fulfilling for me, being able to consult on Grey's Anatomy. That was very, you know, it's just, I've been able to do some really, really exciting things by speaking my mind. So what I would say to the learners and to anyone else.


You do, I mean, I always say to people, don't say Dr. Terri told you to get fired, because I did not say that. I did not tell you to go. I'm not trying to get fired. I need everybody to keep their job. Like we have bills to pay, kids to send to college. Like nobody needs to get fired today. So, but there is a way to distill your talking points for the audience in a way that you feel like you are authentic. You may keep points about literature that's out there and you hopefully provide some recommendations.


Normally when I'm giving a talk, I almost always am using my own personal life experiences, my own personal journey. And I've never really had an employee get upset about that because it's my personal journey. I think it's different if you feel like you're in a toxic work environment and you're talking about things that need to be improved there. If that's gonna be your platform, then that needs to be your platform with your lawyer once you leave.


Daphna Yasova Barbeau, MD (she/her) (01:11:36.124)

Mm-hmm.


Terri Major-Kincade (01:11:48.433)

But while you're there, if there are things you're passionate about, because the public wants to hear from us. We are trusted. Even though physicians get demonized, people still trust us and value what we have to say. And people want to know that we care about how they're experiencing things. And for those of us who aren't in academia, I love it, like on Twitter, when people just still.


This study came out, these are the three bullets. I love when you guys sent out the summary of the important journal articles. I'm like, great. I'm like, where is it? Cause I can't even, it's too much stuff. Like I love to get it distilled in bite-sized pieces. So there are ways to be your authentic self, be able to share. Sometimes people are all over the place. You have to kind of figure out like, what is your main, like Ben said, gift of hope. For me, I say that my mission is to inspire


Daphna Yasova Barbeau, MD (she/her) (01:12:39.001)

Hmm.


Terri Major-Kincade (01:12:41.625)

people navigating life's journey with the gift of hope and they may be my colleagues, my patients, my friends, my family. Whoever I meet, I'm trying to leave them with a way to reframe their life in a way that they have hope. And so figure out what your key points are. You can share the evidence. Always add your own personal experience because that is something the employee doesn't really have a problem with. It's when you talk about work systems, work dynamics, structure and processes.


that you feel are hindering patient care or your job performance, when you share that in a public platform and your employee doesn't have a way to respond in a way that allows them to have the same equal, that's when people get into trouble. Because a lot of times the person doesn't know you had this issue and now they're finding it out in social media. That is when employees get concerned. Now you did say, you mentioned, you were definitely, one of you guys did say,


Daphna Yasova Barbeau, MD (she/her) (01:13:33.308)

Hmm.


Terri Major-Kincade (01:13:39.397)

we're finding we can say this, we can say that. So, you know, this job I have now, there were some clear things that I cannot personally give an opinion on as an employee of the state. And so I don't, but I certainly can have offline conversations with people because, you know, I have free speech and I'm an intellectual person and I'm learning and I'm growing and I'm gathering new experiences. But I'm still able, so one of the things that was really helpful for me, especially for learners,


or anybody navigating their career is being mentioned. We've been taught and ingrained that we can't do this. So when everybody heard I was coming back to academia, people were like, you're never going to be able to keep being Dr. Terri MD. You're not going to be able to release the books. You're not going to be able to consult for Pamper. You're not going to be. People told me all these things that I would not be able to do. And I would just say, give your employee the chance to help you design the life and the career that you want to have. Give them the chance to say no.


Daphna Yasova Barbeau, MD (she/her) (01:14:21.01)

Hmm.


Daphna Yasova Barbeau, MD (she/her) (01:14:32.532)

Hmm.


Terri Major-Kincade (01:14:36.941)

And they may not say yes, they may say yes to eight things and say no to number nine and 10, but at least you got the eight. Whatever it is that you're thinking or other things that you want to do with your career, use your expertise, use your platform. I would say, give them the chance to say no and then go from there because they may say yes, or they may say we'd love to partner with that and can you develop a curriculum around it for us? And so there are so many wonderful things happening just because...


Daphna Yasova Barbeau, MD (she/her) (01:14:59.688)

Mm-hmm.


Terri Major-Kincade (01:15:05.657)

of me being free to use my voice. So, but don't get fired.


Daphna Yasova Barbeau, MD (she/her) (01:15:09.464)

I love that. I think that's... Don't get by. I think that's really great advice. And actually, you mentioned your books. We've talked a lot about your book, Full Circle Moments, what 20 years in neonatology taught me about life, love, and loss, but that is not your only book. You also wrote Early Arrival, Nine Things Parents Need to Know About Life in the ICU Nursery. You've collaborated on a number of books.


Ben Courchia MD (01:15:10.158)

I'm out.


Daphna Yasova Barbeau, MD (she/her) (01:15:34.508)

And you've written some books for siblings, P is for preemie and big sis visits, the NICU and its adjacent coloring book. So my last question is really, where do you find the time? Where do you find the energy? And why was it important to you? You know, it's not just social media, but to go out there and write it down and have it there, you know, for the long.


Terri Major-Kincade (01:16:00.377)

Yeah, so I'm not a Pulitzer Prize winning author by any means, but it's really important to me to make sure we, even the playing ground for health literacy and access to information. And so many of us who are in medicine, the way we share information with our friends is the way we share information with each other, data points. And so people leave the conversation not really being able to act. So the nine things parents need to know about the NICU, that's really for the person


who went into labor, baby suddenly got admitted to the NICU and they are in a world that they hadn't planned for. It could be read in one sitting, one hour at the most, but gives parents like quick lingo and questions to ask and five things to ask your providers. So what people like about that book the most is the very last page is five things to ask your providers. In fact, people will message me and go, Terri, I know I met somebody who read your book today because at the end they asked me these five questions because I always tell people to ask.


Daphna Yasova Barbeau, MD (she/her) (01:16:57.02)

That's awesome.


Terri Major-Kincade (01:16:59.273)

Is there anything you're worried about today that you didn't tell me? Because you know how you're going to the bedside, you're all afraid that the parents gonna ask you about, well, what if this doesn't work? But then they don't ask, so you're happy. But if the parent says to you, is there anything you're worried about today that we didn't talk about doctor that we need to talk about a plan for? I'm like, that's the question. So people always know. So that was why. And in full circle moments, I love neonatology, but I knew I was gonna be transitioning to pediatric palliative care full-time.


Daphna Yasova Barbeau, MD (she/her) (01:17:15.995)

That's right.


Terri Major-Kincade (01:17:25.997)

I still do neonatology one week and a month, but I really wanted to just capture some of the life lessons I've had along the way from parents and colleagues, just to kind of like as a point of gratitude. So that's why I wrote that. And then for the children's books, we've talked a lot about disparities. I really wanted to have a book. I wanted to do two things with the Big Sizzle Business at NICU. I wanted to have a book.


that showed a family of color that had two parents, you know, and navigating experience. And I wanted them to go to a hospital with people that looked like them. And so somebody literally said to me, did you realize that there was only one person in the book who's not, I'm like, yes, I did realize. I intentionally, did you realize that most of the books I read, like everybody in the book does not look like me except for one person, like somebody like literally thought it was a girl. But what I really liked about that Vixen's Business


Daphna Yasova Barbeau, MD (she/her) (01:18:08.856)

Yeah. All right.


Ben Courchia MD (01:18:09.219)

Hahahaha


Daphna Yasova Barbeau, MD (she/her) (01:18:16.56)

Right.


Terri Major-Kincade (01:18:22.489)

palliative care attendings. His son was a preemie and he loves that bigsist business, the NICU book, and he said a couple of weekends ago they were he asked his son what he wanted to play and his son was like let's play NICU today and he was like well how do you play NICU? He said you know the baby has to get an NG tube and I was like did y'all get a tube? He's like Terri, he's three, we just grabbed something taped it to the side of the dog's face and went kept playing.


Daphna Yasova Barbeau, MD (she/her) (01:18:36.025)

Oh


Ben Courchia MD (01:18:41.112)

Haha


Terri Major-Kincade (01:18:49.885)

And I was like, oh, because they didn't go in, I was asking. So I really love that for siblings. To me, that's a gift from the mom that gave us Siblings Sunday. And then P is for pre-me. I really love reading. And board books were my favorite because it's a book and a toy. You can read it, throw it, you can chew on it. It's like a multi. And so I really wanted to do an ABC book just celebrating all families who navigate that journey and all different types of families. So.


That was fun. So where did I have the time? I worked nights for 15 years. Remember I told you guys I don't like the TPN, I don't like the residuals and the desats. I like deliveries and admission. So I worked nights for 15 years, talking about making your life fit into your, making work fit into your life. I only worked Friday, Saturday, Sunday night for 15 years. When I went into private practice, they gave me that gift because they knew I was leaving academia because I wanted to see my kids and see my husband. And so I only worked nights. So


Daphna Yasova Barbeau, MD (she/her) (01:19:27.634)

Hehehe


Terri Major-Kincade (01:19:48.917)

I still am a bit of a night out. So I do most of my writing at night. And the P is for preemie book and the B is for, Bix is for business to NICU book. I knew I was going into fellowship and I wanted to have those written before I went into fellowship because I didn't want them to be like, when did the fellow have time to write two books? Send us all the checks. So I made sure I got those done before. So that's it, that's pretty much. I wanna write a book about normalizing


the right to be able to do medicine differently, because I don't think that we normalize that for learners. We pretty much, you know, we finish our training and you stay in academia and you publish and you get your tenure, and that's the way you're supposed to do it. So if you don't do it that way, you can be looked at as less than successful. So I really wanna be able to write a book on you have the right to do it differently. And


Daphna Yasova Barbeau, MD (she/her) (01:20:22.568)

Hmm


Daphna Yasova Barbeau, MD (she/her) (01:20:43.423)

Hmm.


Terri Major-Kincade (01:20:48.445)

you have different seasons. The way I'm doing my life now is very different than I did when my kids were little. It's very different than I did when I first finished fellowship and we have to normalize for people that you have the right to reset and reframe and have a new pathway.


Ben Courchia MD (01:21:01.3)

100% That's so good


Daphna Yasova Barbeau, MD (she/her) (01:21:04.912)

Well, there's definitely a need for it and we will be looking for it for sure. Dr. Terri Major-Kincaid, you have left us with a ton of insights and clinical pearls and we thank you so much for your time and everything you continue to do.


Terri Major-Kincade (01:21:10.205)

Okay.


Terri Major-Kincade (01:21:20.485)

Thank you guys for having me. I had a blast. It's like a mini vacay.


Ben Courchia MD (01:21:23.586)

Same here.


Daphna Yasova Barbeau, MD (she/her) (01:21:24.648)

pleasure.


Daphna Yasova Barbeau, MD (she/her) (01:21:28.899)

All right, well thank you so much.



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