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#199 - Writing and Healing in the NICU (ft Rachel Fleishman)





Hello Friends 👋

In this episode of the Incubator Podcast, Daphna Barbeau and Ben Courchia are joined by Dr. Rachel Fleishman, a neonatologist, writer, and advocate for narrative medicine in neonatal care. Dr. Fleishman shares her journey in discovering the power of storytelling and its potential to humanize and transform the NICU experience for providers, patients, and families alike. She discusses the importance of listening beyond the numbers and medical jargon to truly understand and empathize with the stories of those involved in neonatal care. Dr. Fleishman also explores the role of writing as a tool for personal reflection, healing, and advocacy, emphasizing the value of embracing creativity in medicine. The conversation delves into the challenges and rewards of bridging the gap between the analytical world of medicine and the humanistic approach of narrative, ultimately highlighting the transformative potential of storytelling in the NICU. The episode concludes with an exciting announcement of a collaborative project between Dr. Fleishman and the Incubator Podcast, aimed at fostering a community of neonatal storytellers and showcasing their powerful narratives at the upcoming Delphi Neonatal Innovation Conference.


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Find out more about Dr. Rachel Fleishman at - https://www.rachelfleishman.com/


You can register for the Delphi Conference via this link - https://www.the-incubator.org/event-details/delphi-2024


Consider joining our special event at Delphi 2024 - Reflections from the NICU




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


Ben Courchia MD (00:00.879)

Hello everybody, welcome back to the incubator podcast. We are back, it's Sunday. We have a great interview lined up for us this morning. Daphne, how are you? How are you this morning?

 

Daphna Barbeau (00:10.566)

I'm doing really well. We have been talking about this interview for months and months and months because we've got some exciting things to announce at the end of the interview, I think.

 

Ben Courchia MD (00:20.999)

Yeah, I think this is going to be a jam-packed interview because there's a lot of stuff for us to go through. We're honored to have with us Dr. Rachel Fleischmann, who for those of you who are not familiar with her work, I'm just going to go quickly through her bio. Rachel is a neonatologist at Jefferson Einstein Hospital in Philadelphia, where she's also an assistant professor of pediatrics and the director of narrative medicine. She's a published physician author whose narrative

 

in prestigious publications such as Time Magazine, Lancet, JAMA, and many more. She is very active on social media, on ex-formerly known as Twitter at rafleischman. Rachel, good morning. Thank you so much for making the time to be on with us today.

 

Rachel Fleishman (01:06.594)

Thank you so much for having me. I'm so excited to join you and finally meet you in virtual person, semi-person.

 

Ben Courchia MD (01:11.651)

Semi-person. Yeah. Um, um, Daphna has been very excited about this interview. So I'm going to just mute myself and let her get us started.

 

Daphna Barbeau (01:21.854)

Yeah, well, we have a lot of things we want to talk to you about today, but I think one of the common themes is using kind of the humanities in medicine. And I think that actually says a lot about who you are as a person and as a doctor, but I'm hoping for people who are hearing kind of this term like narrative medicine for the first time, that you can tell us a little bit about that and the history of narrative in medicine.

 

why it's important, especially for people in our community.

 

Rachel Fleishman (01:53.87)

Sure, thank you so much for asking me. I feel honored to even be asked that question because there's this lofty pedagogy of which I am a teeny part. And so it feels amazing to be representing a little bit of that to the neonatal community. Narrative medicine is this theoretical construct that was envisioned or developed.

 

by Dr. Rita Sharon, who's an internal medicine physician at Columbia in New York, who holds a dual degree. She has a PhD in English. And through her study of English literature, she is a Henry James scholar, if I remember correctly, and what she calls narratology, or the study and science of storytelling, she translated that back into her role.

 

as an internist who in her office practice was listening all day to her patients and realizing that there were a lot of parallels between listening to patients tell her what was going on with them and filtering that into a cogent medical story and the type of storytelling that was done in the English.

 

Rachel Fleishman (03:18.114)

academic English world where they were studying the structure of how stories were told. So she drew a lot of parallels between the work and then went on with many other academic faculty to figure out how they could, with the study of stories, teach physicians how to be more holistic

 

Rachel Fleishman (03:47.618)

patients telling stories in our pediatric world. That would be parents often and our older non neonatal pediatric patients who talk telling stories and also our own stories because we as healthcare workers who are often taught to sort of put our own experience of providing healthcare aside and serve the patients around us.

 

are so caught up in the learning and diagnostics and filtering of other stories that we often don't step back and think about what it means for ourselves as human beings to be providing that care and witnessing sickness and suffering on a daily basis.

 

Daphna Barbeau (04:30.546)

Yeah, I love that. And it makes so much sense to envision, again, our older patients as this story and then for ourselves, our neonatal patients as the story that they are. I wonder, what has narrative medicine meant for you? Why did you get interested in it? You're obviously such a talented writer, but how does that change your…

 

practice of medicine and your experience of being a physician.

 

Rachel Fleishman (05:02.094)

That's a really interesting question. But I was writing long before I ever was a physician. When I was eight years old and I wrote my first short story in Mr. Katz's third grade class, I was enamored with the idea that I could create this world on the page that said anything I wanted it to. When I went off to college, I was taking all these creative writing classes and my-

 

father who's a mechanical engineer said to me, okay, well, Rachel, that's all well and good, but you need to be able to pay your bills when you're done with college and you're really good at these science classes and you, parents, and you like them. And so don't, like, fine, take these writing classes, do all that, whatever, but like, don't stop with the science. And I loved my science classes too. So I sort of did both in college and then I went off to medical school and got swept into the current of medical training. And...

 

Daphna Barbeau (05:36.406)

Parents.

 

Rachel Fleishman (05:57.194)

became a mom and did residency and fellowship and all these things that are exhausting and soul sucking and hard, but also rewarding and amazing at the same time. And then as my kids got older and my career shifted from working in a level four, the first part of my career after training, I was a faculty at St. Christopher's Hospital for Children. And when I shifted to doing more level three work, that was more shift work, I found myself

 

writing again and looking for an outlet for my writing. I found myself writing about decades of medical care, trying to make sense of some of the hardest things that I had seen as a physician and using the same literary techniques that I had learned in college, they tell you write what you know. Well, what I knew was babies, patients working as a doctor, and I knew it better than I knew many other things.

 

And then I stumbled upon this idea and construct of narrative medicine that was going on at Columbia. I went up to their conference and suddenly I had a language to explain the work that I was doing for myself on the page. And I also started to learn through a mentor of mine, her name's Naomi Rosenberg, she's here in Philly at Temple. I went down Broad Street from my own hospital to...

 

to Temple and watched her and her colleague, Mike Vitez, teach the medical students there. And I was like, oh, this is where I belong. Like all this quality improvement stuff I've been doing, no, this is amazing. This is where I fit. And so I just kept, it spoke to me. It made sense in this way that maybe didn't always make sense to the other things I was doing. And...

 

Daphna Barbeau (07:36.81)

It spoke to you.

 

Rachel Fleishman (07:45.618)

I also at the same time had an amazing mentor, my chair of pediatrics at the time at Einstein. Her name is Maddie Irrigoyen, who had come from Columbia. She had run the academic general Peds fellowship at Columbia for a long time before she became the chair of pediatrics at Einstein. And so she was familiar with Rita Sharon. And instead of going to her and saying, I wanna do this thing and her saying, what is that? I've never heard of that.

 

do this other thing that makes sense that I understand. She was like, ah, I get it. I know what this is. I know how to mentor you. I know how to push you in all the right ways. And so I just kept going.

 

Ben Courchia MD (08:28.267)

Rachel, I think it's interesting what you're mentioning because to me, I'm quite fascinated by people like you who are able to merge and marry both processes, the medical endeavor and the creative writing aspect of narrative medicine. And the reason I'm saying this is because as we train to become physicians, we are told to be extremely analytical. And so...

 

Interestingly enough, as you mentioned in the beginning of the interview, both in the way we listen and in the way we speak. So we are told to listen to a patient's story, but out abstract the facts that I can just then put on my differential. And then we're told to speak in a very analytical process because medicine is a science. And so I'm always curious as to...

 

Do you, how, can you explain to us how these two processes are not opposites, but they actually can work together effectively? I think that's something that a lot of us are struggling with.

 

Rachel Fleishman (09:32.026)

I think it's really hard what we do. And we have a lot of training, particularly in the NICU. We have our own language. The language that we use in the NICU, the jargon is unlike anything else in medicine. The medical students come into my NICU now and I tell them, save up your questions so we can get through rounds. Because if we spent all of rounds on the med student questions, the work wouldn't get done, but also they're learners and they need their questions answered. And inevitably the very first question they ask

 

It has something to do with the crazy abbreviated Latin language that we use. It's distinct, it's like medicine, but more on steroids, right? And I think that it's all really important to understand the amazing pathophysiology that is the neonate and be able to describe that with accurate jargon, because it allows us to figure out what's going on with our patients and treat them. I'm not diminishing that. It's really hard.

 

But also we need to be able to turn that off and turn on the language of being a person and be able to both talk to parents, talk to nurses, talk to each other without that medical language. And we spend so much of our lives learning all of that jargon and neonatal language that it's really hard.

 

sometimes to remember that is not the whole story. And I think in the NICU, when our patients are babies who don't talk to us, there are all these parallel stories going on around the baby. The nurses have their own story of the patient, right? We believe the nurses are our eyes and ears because they are the ones at the bedside. And so...

 

a lot of the way that we see the medicine in front of us comes through the stories the nurses tell us of the patient. This one's really fussy. This one's really scoochy. This one's really agitated. This one's too sleepy. Please wean the morphine, right? And yet the parents have their own stories. And then last of all, we have our own stories and we're not really taught to voice them per se because if we spend all our time talking about ourselves,

 

Rachel Fleishman (11:54.178)

We're not necessarily there serving the needs of others, but we have to sometimes talk about ourselves or we just become emotionally depleted, right? It is hard work what we do. And so learning to shift back and forth between the complex language of neonatal medicine and the non-complicated language that parents need and the personal language that we need to make sense of the things that we see is tricky.

 

That's very tricky. And writing is my way to do that. It's not the only way. Lots of people have other ways, right? People go up to happy hour, they complain, they talk to spouses, they have besties who are other NICU docs and they talk about stuff in the, you know, after sign out, you need to talk about these things. There's many different ways. This is my filtered way.

 

Ben Courchia MD (12:48.175)

Before we get back to how we talk about these stories or how we tell these stories, I wanted to ask you one more question about listening to stories and shifting our brains a little bit away from this 100% complete analytical mind. Can you tell us a little bit how listening, and I emphasize the word, not just hearing, but listening to these stories can actually impact the care you deliver to yield better results? Because I think...

 

Many times we can think, oh, this is kind of nice. Like it's an extra thing you could do to just pay more attention. But we don't some, we sometimes lose track of the fact that by listening to the story, you can actually direct the care to be even more appropriate than what would have originally been attended if you just looked at this from the very analytical process.

 

Rachel Fleishman (13:36.91)

I mean, I think that's true both a lot for the parents. I think it's also true for ourselves and for the nurses. I think with respect to the families, that's the potential to make in many ways, I don't wanna say the most difference, but a lot of difference. There was an article, I don't remember when in the last year, and I'm gonna do the authors and injustice because I don't recall who wrote it, but the title of the article in the Journal of Periodontology was like something along the lines of words matter. And I saw this article and I was like, yes.

 

These are my people. The way that we speak to families colors the way that they see their care and their children's care. 100% of people whose children are in the NICU don't want their babies in the NICU. Nobody, whether their pregnancy is planned or unplanned, expected or unexpected, nobody believes that their baby is gonna need advanced intensive care at birth, no one.

 

Ben Courchia MD (14:35.147)

Yeah, the paper was called Words Matter, Exploring Communication Between Parents and Neonatologists. First author is Roger Winters, and it's in the Journal of Perinatology, as you mentioned. Of course.

 

Rachel Fleishman (14:43.983)

Thank you for that, yes. So the way that we talk to families who are all in some state of coping in crisis with some unexpected issue, shapes the way that they see what's going on. And because they're going through something that's very hard, they latch onto words and remember them. Like any...

 

So many memories as human beings are made because there's an aberration in the day-to-day rhythm, right? That you remember the day that you had your first baby because it's different than every other day because your child was born You remember the day that some you know 9-eleven because it was different than all the days before and after it When when parents are in this state where their babies in the hospital there or their older non baby is in the house You know child is in the hospital

 

they're listening to your words through this lens where they're gonna harp and sort of grasp. And we've all experienced this, right? Well, the doctor said, blah, blah. And maybe you did, or maybe you didn't, or maybe they remembered it in a way that wasn't your intent, but they're stressed and they're scared. And talking to them in jargon is not always the best way to make them feel.

 

comfortable and confident. It's not that they don't need to know what's going on with their child. It is not unimportant that we're weaning the CPAP or adding two more mill equivalents of sodium acetate to the TPM. Those things matter. I'm not saying they don't matter. And we all are very good at making those tiny choices that we know as neonatal providers matter to the outcomes for our patients. I'm not trying to diminish that at all. But when we...

 

translate the whole plan for the day as I went down on the ventilator by five breaths and I gave more acetate and we might start one milliliter of breast milk by c-liter. The parents, some of them have been in the NICU for weeks at that point and they're like, yeah, okay. But some of them, they want this much more, you know, existential answer. Like, is my child going to survive? Is my baby going to make it through the day? When can I go home? What is going to happen to my kid?

 

Rachel Fleishman (16:59.274)

and the sodium acetate and the ventilator changes, they may or may not care, but that's not the answer. And we don't also always have the answer. I'm sure we've all had the experience where the baby's born and it's maybe a complicated or stressful delivery, or maybe it's a perivital patient, you're not entirely sure what the long-term outcome is gonna be, you're pretty worried, and the mom's like, when can my baby go home? And you're like, mind explodes because you're just like, let me make it through the next four hours, right?

 

And so it's not that we need to have the answer, but there's a really big difference when a mom says to you, when can my baby go home? And you say to her, there's a 24% chance that your baby will survive. That's one answer, that's true. Or you say, I'm not sure, I don't know yet. That's a human answer. And one maybe resonates with a family and the other may not. And...

 

Different families want different amounts of information based on their health literacy, their, you know, proficiency with statistics, etc. I'm not saying one answer is always better than the other, but being attuned to the humanity behind the questions that the parents are seeking or articulating allows you to answer their questions in a way that maybe you could not if

 

Daphna Barbeau (18:26.466)

Mm-hmm.

 

Rachel Fleishman (18:27.442)

parallel point about our own stories, but now I've lost it. You asked like a question and I, sorry, I'm rambling now, be quiet.

 

Daphna Barbeau (18:39.384)

Do you remember your question, Ben, that you just asked? Okay.

 

Rachel Fleishman (18:41.779)

I don't remember how we started on this long train. I'm hoping this rambling will not.

 

Ben Courchia MD (18:45.143)

We started on this long train because we think that both the concept of analyzing a patient's case and their stories are not incompatible with the delivery of care. And that both actually can be synergistic in how you deliver care.

 

Daphna Barbeau (18:51.106)

Oh.

 

Daphna Barbeau (18:56.208)

That it might make you a better physician. Yeah.

 

Rachel Fleishman (18:58.566)

Right. So the other piece of that is when we get so drawn up in the jargon that we are explaining to ourselves what's going on around us only with the jargon of medicine, we lose sense of the fact that we have feelings and intense reactions to the things that are going on around us. So the very first pieces I ever wrote were about dead babies. A friend of mine was like,

 

I said, you know, I've been writing all these dead baby articles. And she was like, that's interesting that you think that's what you're writing about. I was like, no, but it is. She's like, no, but it's, it's not. Um, because it's, that's the hardest thing we see. I mean, death is hard to witness as a physician, but it's also an incredibly important part of what we do is chaperoning families through end of life care. Being able to give yourself permission to tell the stories of the hard things that we witness.

 

not when you're in front of the patient, but because that's not the time, but on your own, whenever it is that you make space to frame it, allows you to not be totally a depersonalized and sort of robotic physician. And while burnout is a multifactorial problem that is a lot structural, there is this component of burnout that comes from the fact that a lot of the work we do gets

 

devalued because we provide a service and if we stop to think too much while we're providing care, we'd crumble, right? We can't always be thinking emotionally at work. It doesn't, you know, you can't be in the delivery room in a crisis thinking, how does this make me feel or what's the story here? But you can reframe it for yourself later so that you can ascribe whatever the meaning is for you to that incident.

 

Ben Courchia MD (20:54.803)

Something interesting about that is because, as we mentioned on one of our very early episodes with Perry class, the fact that medicine, you're confronting death all the time, but confronting the death of a child is inhumane. It's not something that we're wired for. Our whole DNA as humans is wired to try to get babies to survive. That's preservation of our species. And so there's something in our opinion, at least, that's even more

 

pronounced when a child dies because of this, because it goes against every fiber of our being that these beings should survive. So I completely understand how these experiences are significant and even more significant for us as physicians considering our patient population.

 

Daphna Barbeau (21:42.114)

What I love about what you said is it's, I think, really a metaphor for humans, physicians are humans, right? Or healthcare professionals are humans in medicine and we're asked to do these very not human things sometimes. Or human things, right? Bringing life into the world, shepherding life out of the world, those are human things, but in a totally non-human way, right? This sterile…

 

way and medical education swings back and forth, but we've really been taught to like not do those things in a human way. And I think it's a good reminder that like there's more than one way to do it. And sometimes bringing in that humanness, I think is of value to the work, especially that we do in the NICU. And so I want to talk about your professional writing, obviously. But first I was hoping

 

You know, for people who are like, I mean, I dig it. I get it. I want to write. I want to sit down and do it. I just, I just don't have a process for that. So for people who are like, okay, maybe I could try it. Like I've thought about things. I'd like to put pen to paper. You know, narrative medicine is obviously this very structured thing technically, but people can still just write if they wanted to write. Like how do you recommend people get started?

 

Rachel Fleishman (23:06.154)

I mean, so one of the most important things to remember is there's no bad writing. Like writing is a tool just like any other educational tool. And the difference between reflective writing and creative writing is, there are differences between reflective writing and creative writing. And...

 

reflective writing, which is a component of a formal narrative medicine workshop, we in those sort of structured workshops, we read a short piece, and then we talk about the text. And then I have my pediatric residents, right, which makes them all uncomfortable, mostly because they're in the middle of their workday, depersonalizing their world. And I want them to like turn inward and reflect on some poem. And they're just like, not all of them, but often.

 

Poetry? It's 1230. My pager is beeping, right? So, but I think understanding that to get from just this practice of journaling or reflecting or jotting stuff down towards a creative product that then you submit out into the world is a lot about revision. And not everyone...

 

needs or wants to undertake the laborious and tedious process of revising their reflections to become something that then has a double effect of like, I personally feel fulfilled when I create a piece for others, but the work of revision is how it shapes and then it goes off into the world and maybe has some other effect for the reader that is apart from me. And so I think the

 

for people who are interested in reflection, just don't get caught up in the fact that someone ever needs to see it. Just put the pencil to the page and just let it out. And do not worry what appears on the page. Just keep going. And if you never look at it again, or you come back to it and rework it once, twice, maybe you come back to it years from now, which is some of my earliest published things like...

 

Rachel Fleishman (25:25.814)

found these ramblings from residency and I was like, oh, it's time. Like, I had years of distance from the thing, but the thing had been written so freshly when I first wrote it that the details of the thing were poignant, whereas I would not necessarily remember those details all those years later. But through the distance and revision, you can then shape the piece so that it is appropriate to then send it out. I don't want to say appropriate. It's...

 

Rachel Fleishman (25:57.879)

tailored for a reader, right? And depending on where you're gonna put it, the type of choices that you make through revision will be shaped for the type of reader that you're targeting.

 

Daphna Barbeau (26:11.81)

And then do you have like a personal journaling practice? Like how does that look for you on the day to day, week to week basis?

 

Rachel Fleishman (26:21.606)

Oh, no. I mean, I, like many neonatologists, am a shift worker. And I'm grateful that writing is not my real job, because if I had to do it on a schedule or on a structure that was not my own, then I would no longer be writing for myself, I would be writing for work. And then I think my own quest to find meaning on the page would maybe be...

 

Daphna Barbeau (26:34.198)

Hehehe

 

Rachel Fleishman (26:51.822)

corrupted by this sort of need to make it into a task. And so I write when I am moved to write. Lately, I have been in the process of working on a longer project that revise, revision is where I spend most of my writing hours when I am pulled there lately.

 

Daphna Barbeau (27:13.218)

And then I have one more question about kind of the structured narrative medicine. If people want to get involved in that, are there places people can go to learn more?

 

Rachel Fleishman (27:24.214)

Totally. So Columbia runs, they definitely run a fall, they call it the Basic Narrative Medicine Workshop. You can get CME, it's three days, it's in New York City, so you can marry your trip with your desire to go do whatever it is you'd like to do in New York City. There's a Narrative Medicine Facilitator Training run out of somewhere in Oregon, to be honest. It's like a Northwest.

 

some type of, I should know the name, but I do not. So there's a training there. Columbia runs like formal masters and certificate programs. So if you're so moved to really become academically engaged with the pedagogy, as opposed to my mostly do what I would call translational work, right? Like somebody has to come up with the theory, somebody has to do the lab work.

 

Daphna Barbeau (27:58.932)

Okay.

 

Rachel Fleishman (28:23.074)

whether it's either in narrative medicine or whether it's in microbiology, and then someone has to translate that to the actual healthcare workers, which is where I sort of live. And there is a big humanities center in Toronto. They run online classes in health humanities or medical humanities, so you could also pursue things there. And then more and more as this is cropping up, not just...

 

in adult medicine, but in pediatrics, people are giving one-off conferences. Teaching is happening at different pediatric hospitals around the country. I have done invited workshops at different places, either teaching narrative medicine or talking about the theory, just a little bit like what we're doing here. There's a smattering of people that I know in pediatrics around the country who just sort of do it. They teach it.

 

to their trainees or their departments.

 

Ben Courchia MD (29:23.726)

Rachel, my next question for you is when you guys, you and Daphne were talking about like putting pen to paper and I feel like for many of us as physicians, we do this and we start writing and I know you said there's no such thing as bad writing. Fine. Okay, granted. But you start writing and you're like, I'm writing a case report here. Like this is no fun. How do we break out of this shell of like, I'm going to write about this story without talking about

 

Daphna Barbeau (29:43.862)

Huh.

 

Ben Courchia MD (29:51.986)

The patient presented at 6 a.m. in the morning with complaints of XYZ. And it's like, man, I'm writing a chief complaint and this is a soap note. This is awful. How do we, how do we get out of this, of this rut of just writing soap notes?

 

Rachel Fleishman (30:05.471)

I mean, first stop telling yourself it's awful. Like that's the first step, right? And like, so you wrote a soap note, like you wrote it for yourself, right? So you, it is true that we are conditioned to like tell the patient story or the baby story in a certain way, right? This is a 49 day old ex 26 week baby born to a right. And like, so what if you write that? Like just keep going. If you-

 

Ben Courchia MD (30:24.892)

Right.

 

Rachel Fleishman (30:33.102)

keep going long enough, you will eventually stop telling that pre-programmed medical chart story and dive, you know, veer into something else. Just be patient with yourself. And maybe the first time you do just write a medical anecdote in medical jargon. So what? That's not a bad thing. It's not.

 

let yourself just be patient with whatever it is that you need to put on the page. And also understand that to write is to commit to thought and you're committing to it. Like we have thoughts all day long, but we don't always pick the ones that we think are important and write them down. And to put them on the page, the process or act of doing that is...

 

for some people easier than others. And so knowing that even just getting to the point where you're willing to sit down and crystallize something with a pen or with a keyboard is not always easy depending on who you are and how you think.

 

Ben Courchia MD (31:45.18)

Mm-hmm.

 

Daphna Barbeau (31:47.918)

Um, I love that. And I hope people will take you up on, uh, this expertise to just put, put pen to paper. Um, but of course we want to talk about some of your professional work. Um, I'm just want to tell you some of my favorite pieces because I started reading your pieces of just a handful of years ago, and then I was like, I want to read more. And so we, I did find your website pretty early on in my career. And I actually, um, love that you put.

 

your works there for people to find them all. But my favorites are Dreams Deferred Yesterday and The Hardest Step. They kind of really resonated with me as a physician and the things that I carry home with me. So I really encourage people to read those, but you've also written a lot about...

 

What's going on in our community? What's going on with the pandemic? What's going on with Roe v. Wade and changing, you know, sociopolitical things that do affect our work and in, in the NICU and, and your work has been well received, very powerful. I think it gets people talking. So what made you take the next step to do the refinement, to do the revision and then submit something professionally?

 

Rachel Fleishman (33:09.046)

That's a really good question. I mean, the very first pieces that I wrote, and I say this because it's easy to find one article in Time Magazine and be like, oh, I could never do that. But I started by publishing in medical humanities journals. And there are a few out there and, you know, they're read by other people who like to read stories by.

 

healthcare workers about the provision of patient care. And so if you're writing and you're listening to this and you get to the point of revising and then you wanna send it out, like you can either spend some time on Google University, Stanford's Medicine in the Muse program has a non-complete but pretty good list of medical humanities journals that take stories. You have to be a little careful with that. There's some ethics involved in writing patient stories, which is a...

 

separate conversation. But then the stories you're mentioning are in PubMed physician journals because they're things that I struggled with as a physician and nobody really out in the world outside healthcare wants to read about how hard it is for the doctor to care for patients who've passed away, which two of those essays you mentioned are about exactly that. But there's lots of doctors who need an outlet

 

be, you know, have some sort of healing process. And I'm glad to know that my words reached others who do that work. And then the question for myself was like, well, do I keep going as a writer? So there's this like professional world of writing out there. And Perry, you mentioned Perry Class, who I've had the pleasure of talking with and emulate her career in many ways.

 

And there are ways that one can grow as a writer that have not so much to do with being a physician. But I have chosen to write not only as a physician, but often as a physician because there's power there. And I find that I can advocate and or.

 

Rachel Fleishman (35:28.502)

leverage the work that I do in a way to bring understanding to things that are important to me as a physician. I work in North Philadelphia, which is a very impoverished section of Philly. And I see hard things because of poverty, because of structural racism, because of immigration, and because of our disparate, you know,

 

private versus public in many ways, healthcare system that sit hard with me and have for a long time. And to be able to revise and cultivate my voice in a way that I feel like I'm not just going to work and seeing all this stuff and then going home and have no outlet, I made myself an outlet. And so I just kept going and I've been fortunate that there are other, not necessarily in neonatology, but in medicine, like other.

 

you know, doctors who write, who've had very successful careers. Perry Klaus is a famous pediatric writer, but there are, you know, Atul Gawande and Abraham Verghese are some famous ones, but there are lots of people that are medium famous. Rana Aldish in Detroit, who had a very successful memoir, and I have met with her as well. So there's other physician writers who have helped me chase that path and point me towards

 

Daphna Barbeau (36:42.784)

Mm-hmm.

 

Rachel Fleishman (36:55.682)

writing goals that I then align with as a physician.

 

Daphna Barbeau (37:01.218)

I actually love that you bring that up. That's a point I wanted to mention that, you know, the data shows that, you know, physician publications are pretty well received by our communities and that actually people want to hear from physicians in their communities. And I wonder, I think sometimes, especially for early-career NEOs and trainees, like this term advocacy can sometimes feel very, very big. But I think that, I mean, this work that you're doing.

 

is considered advocacy work, you know, making change, bringing attention to the needs of your community. And I wonder, there are not a lot of physicians doing it in this way, even though we know it's well received by the lay public. And so I wonder, like, how important do you think it is for more doctors to be going and writing about their perspectives and the problems in their community?

 

Rachel Fleishman (37:56.426)

I mean, I think like we play to our strengths, right? So some people who do advocacy are really enamored with working with their legislators and knowing what's going on in Capitol Hill and fighting for bills and all of that is really, really super important. But there's many, many ways to advocate, right? We advocate for our patients every single day in the NICU because we are literally

 

championing their survival. And so I don't underestimate like this big fancy word advocacy that's now being total around that actually as pediatricians and as neonatal providers who are saving the lives of children and babies, that in and of itself is a form of advocacy. I think how people choose to take their stature as physicians and

 

project that into the world outside the NICU is a deeply personal thing. And we all only have so much bandwidth. So, you know, there's certainly nothing wrong with going to work and advocating for your patients while they're there and doing your job and going home and then embracing the world as a non-physician. I think that more as I get older, I understand that is really important. We can't always be doing something. And we definitely can't always be doing something as professionals. But my own particular

 

form of advocacy I've played to my strengths. I love to write. I love to cultivate these stories on the page. I find it immensely personally fulfilling. And so that's the way that I have chosen to further a sort of broader advocacy agenda outside of my bedside care.

 

Daphna Barbeau (39:48.222)

And I wanted to talk about other opportunities for, you know, getting your writing out there so that anybody who might be feeling like they can do it. I actually get a lot of my doctor writing fix on social media. So there are a number of physicians, particularly on X, and there are problems obviously with the platform. But that...

 

that put out their writing first, it seems like, on these social media platforms, and then they parlay them into a book or talk or things like that. What do you think about that as an outlet?

 

Rachel Fleishman (40:25.898)

I think, again, if that is the whole world of social media and providing patient or parent education through that forum is a world that I don't, I respect and think is really important. I think their social media is one of many ways to talk to people outside of the hospital. I'm not particularly adept at it. I'm happy to write my article and let...

 

whatever public platform send it out to the people. I tend to post my writing and then retreat from social media. Like I have one place that it lives, like on Twitter, or I made it, my residents taught me how to make an Instagram account. So I just made one of those, but I don't really know how to use Instagram. So it's sitting there waiting, sitting there waiting to like just be a place where I post the things. I think, again, like,

 

Daphna Barbeau (41:14.934)

We can help you with that.

 

Rachel Fleishman (41:23.406)

people, there's not a right or wrong. It's just whatever speaks to you and how much time do you have. Certainly people have grown their own personal platform for whatever purpose they have it as to then go on and write books based on their social media messaging. And there's nothing wrong with that. It's not the path that I can advise anyone on, but that doesn't mean it's...

 

bad or good. It just means that it's not the way that I have chosen to fill my advocacy and or non-work time.

 

Daphna Barbeau (42:04.226)

We were talking a little bit off air before we got started about how the feedback for something like this may be very different than how we receive feedback in medicine. And I wonder if that's what keeps people from doing it. You know, whether it's writing or your music or your art or some other passion project that you have, putting it out into the world feels different somehow than the work.

 

we do day to day in the NICU. Can you speak a little bit to that?

 

Rachel Fleishman (42:36.67)

Yeah, I mean, I'm writing for myself and I have these visions of people reading my work, but I generally don't know what happens to my articles when they go out into the world. I don't know who's reading them. I don't know who I'm moving or possibly angering with my words. When people sort of troll at me on the internet, my general feeling is just to non-respond because I've...

 

Daphna Barbeau (42:45.506)

I'm going to go ahead and turn it off.

 

Rachel Fleishman (43:03.69)

worry that once I engage them, then more of them will engage with me. So I just do not engage. And so there is this, I don't want to say lonely, but I think one of the things that social media can provide, since we were just talking about that, is you do get people who, you know, you post the thing, you make your little video of education about BPD or whatever it is. And then immediately you get your likes and your

 

Daphna Barbeau (43:06.76)

Thank you.

 

Rachel Fleishman (43:33.302)

followers and your comments and you can immediately have a conversation there, whether it's whatever platform. When I send my articles out into the world, like I don't really know where they go. I don't know how many people read them. People have conversations about them. I wrote one article after Roe v Wade fell. I felt really, I'd heard stories from my mentors about the Baby Doe era and I felt really

 

deeply afraid as a physician in the NICU that we were gonna get back there and wrote this article with the help of mentors of mine from Seattle Children's and Bioethics, helped me a lot with that article. I think one important piece since we were talking about revision as a tangent is I didn't just wake up on a Tuesday and write that article in a day and then send it out and have it appear.

 

there were weeks and weeks of thought and mentorship and research that went into that piece to get the tone and the messaging cut down. But people read it and I got invited to speak somewhere after that came out and they said, "'Oh, your article has been shared all over the social media.'" And my response was, really? Like, what are people saying? Because nobody actually...

 

Daphna Barbeau (44:53.386)

Hehehehe. Hehehe.

 

Rachel Fleishman (44:59.366)

really came back to me in the NICU world and said, you know, oh, we thought this or this made me feel that or, you know, I don't get that feedback back. And I'm comfortable with that. But not everybody is. I like being in my pajamas writing these things and then not having to engage with the consumer all the time.

 

Daphna Barbeau (45:11.523)

That everybody is.

 

Daphna Barbeau (45:22.626)

Well, I'm glad people like you are doing it so that we have this to read. So I want to make sure that if people haven't read your articles yet or they've read one or two of them and want to read more of them, they can go to your website, rachelfleishman.com, and get a whole smattering of new readings. Unfortunately, we're getting to the near to the end of our time together, but we wanted to talk a little bit about a special collaborative project that we have with you.

 

And maybe I'll outline it a little bit and then you'll maybe tell us why it's so important for our community. How does that sound?

 

Rachel Fleishman (45:58.99)

That sounds so amazing and I'm so excited, like beyond excited.

 

Daphna Barbeau (46:04.074)

Well, people know we've been talking about our Delphi Neonatal Innovation Conference. It's in September of this year, the 23rd to the 25th. And we always like to have a special welcome get together event. But this year we thought really long and hard about how we could make our conference more of an experience for people who come to participate in person.

 

We stumbled upon storytelling as a way to better connect ourselves to each other. We knew that kind of that's what we've been doing with the podcast all along, is inviting people on to tell their stories. I think people have resonated with different stories that they've heard on the podcast. What we wanted to do was offer this kind of intimate opportunity for people.

 

to share stories that they have written or potentially be inspired by our conversation with you today, to get involved with us in the conference and work on some things under some mentorship from you, which is very exciting. So to better define it, we're gonna have a call for writing and you may have a piece to offer up or say, I just, you know, I wanna be part of the journey.

 

And we will do that in just probably a few short weeks. Or you may have seen that come out already. And then have our cohort work through the summer so that we can have this event this evening of storytelling about stories from the ICU, from the NICU during our get together at the Delphi Conference. So.

 

We were thrilled that you accepted this opportunity to be our mentor and our moderator. And so maybe tell us what got you excited about the project.

 

Rachel Fleishman (48:11.542)

I mean, to bring my writing world and my narrative medicine educating world into the mainstream neonatology community and to partner with you all at the incubator and the work you're doing is so cutting edge and important to the field. I like woke up to the, I found the message from you and I went into the kitchen and I was like, it's happening. Scott was like, what's happening? I was like.

 

people get me. He was like, what? Of course people get you. I was like, it's all coming together. Yes, so yeah, I mean, I'm excited to help others. So basically what to paraphrase what you just said, you know, we're gonna have this event, a neonatal storytelling hour that is for us. It is for us who work in the NICU to tell our own stories about what it's like to

 

Daphna Barbeau (48:42.946)

My worlds are colliding!

 

Rachel Fleishman (49:09.058)

be doctors who work with sick babies. And to get to what Ben was saying and what we were talking about before, revision is the hardest part of storytelling. And so my offer is, you know, people will submit some iteration of or draft of the story that they wanna tell at this event. And over the summer, I will help the people who want to tell these stories to revise them

 

the Delphi Conference, we will have an hour of moving, impactful stories that people will tell, and all of us who are present will both support the storytellers, but also feel moved from our own experiences. I think we have a lot to learn when we listen to each other and when we give weight.

 

to the experiences that we uniquely have as neonatal providers. So that's the vision and that's, you know, the plan.

 

Daphna Barbeau (50:16.97)

Yeah, and I thank you for reiterating that. So we'll have a cohort of people who want to write and share their stories. But like you said, the night is for everybody to feel seen, to feel, you know, they're identified with some of the other stories and hopefully bring some of that inspiration and passion, one, back to their work, back to their own units, and maybe to start writing themselves. So we're really excited about that opportunity.

 

And we're so very grateful for you for extending your mentorship because we couldn't do it without you. So we're really excited about that.

 

Rachel Fleishman (50:55.83)

Thank you so much. I'm excited to help build the neonatal community in this way. And I think whatever stories we end up with, hopefully people will then either, you can broadcast them, people can submit them on their own. If they so choose, they don't have to, it'll be a self-contained event, but you will end up with these polished stories with which they can do as they wish after the event as well.

 

Daphna Barbeau (51:23.974)

So everybody who's even remotely interested or you know a colleague who could be interested, definitely keep an eye and an ear out for that call for stories. Rachel, thank you so much for what you're doing as an educator, for what you're doing and getting the work we do in the NICU scene outside the NICU and for your help in the coming months. We're so grateful for you.

 

Rachel Fleishman (51:52.894)

Oh, thank you so much. I'm so excited because I feel like there's going to be this magical hour of neonatal stories, and I'm honored to partner with you to bring that about for everyone.

 

Daphna Barbeau (52:05.086)

It's very exciting indeed. Well, thank you so much for joining us today. I think, I'm hoping lots of people will be inspired and will maybe take the opportunity even before they see us at Delphi to put pen to paper.

 

Rachel Fleishman (52:21.506)

Thank you so much for having me. This has been an awesome interview and I'm really grateful for your forum and for all the work that you guys are doing with this podcast.

 

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