Lauren Rissman
@DrRissman
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Dual-trained #pedsICU + peds palliative care. Views=my own.
United States
Joined September 2017
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Pinned Tweet
Thank you
@JAMANetwork
+
@PreetiNMalani
for publishing this.
I wrote this for the
#womeninmedicine
who came before me + all those who will come after me.
I also wrote this for my daughter- who I hope will 1 day understand why I sometimes miss bedtime
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Sleeping in the hospital as a patient:
10P hospital med
11P home med
12A vitals- shows I have a fever
12:30 motrin
4A vitals
5A lab draw
7A weight check + nursing assessment prior to handoff
8A vitals
Everyone who comes in after 8A: How’d you sleep?
Me: …
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Love is turning on the car to find out your husband filled the gas tank.
I don't need flowers.
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My daughter had a timeout this morning.
Husband said, “Alexa. Set timer for 1 minute.”
Toddler said, “Alexa. Turn it off.”
This doesn’t bode well for adolescence.
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My 101 yo grandfather very casually just dropped that my great grandmother was the 1st woman to get a degree in biochemistry from The University of Michigan!
SO PROUD!
#WomenInScience
#WomenInMedicine
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Within 5 days: I was being worked up for a life-altering diagnosis, my husband's relative died, we didn't have childcare 2/2 COVID, + I was exposed @ work. Would our high-risk, unvaccinated 1 Yo get it?
The attending wrote in my eval that I appeared distracted.
He's right.
1/5
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4K
Had a doctor’s appt yesterday.
The MA asked if I was pregnant or breastfeeding.
Me: We are expecting via surrogate + I know it sounds crazy, but I’m prepping my body to induce lactation.
MA: Congratulations. That is wonderful.
1/
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So. We were at dinner last night.
Someone casually mentioned Emily in Paris.
My husband responded, “Cocomelon and Emily in Paris have the same amount of substance.”
The person sitting across from him replied, “I’m a writer on Emily in Paris”
^couldn’t make this up if I tried.
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When I was a patient in the ICU, I listened to bedside rounds.
The resident presented me as "Dr. Rissman..." and continued with my complex one-liner.
This provided me with so much dignity after it felt like my humanity had been taken away. I'll never forget it.
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Meet Bear!
He arrived unfashionably early but is doing great in the NICU.
Feeling incredible gratitude for our surrogate who made our family complete!
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I just had a debrief with the incredible team who kept me alive during childbirth.
I was told that as I was being transfused 11 units of pRBCs, I reminded them to check + replace my calcium.
^^ Forever an intensivist 🦾
#PedsICU
#CriticalCare
#WomenInMedicine
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A surgeon used to call me, "Rachel."
I told him that wasn't my name.
He said that bc I "look like a Rachel," he was gonna call me that.
I said that if he would keep calling me "Rachel," then I would call him "Rachel" too.
Needless to say, he stopped.
#WomenInMedicine
#PedsICU
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I was distracted because I was trying to figure out how to be a trainee, a patient, a mother, + a supportive partner.
His evaluation of me was not incorrect.
But, it reinforced the fact that medical training doesn't support personhood.
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Medical training does not value personhood.
BUT I would argue, that to feel human, be healthy, and be present in your own life has the potential to make you more present, more whole and more fulfilled as a trainee and by, default, a better team member and physician.
5/5
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The medical system has been around for ages, adores empathy and compassion, + loves the word "Wellness" but does little to promote its action.
It fails to support adult learners, infantilizes us and is incredibly slow to evolve despite our plea to do so.
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The dialogue felt beautiful + without judgement.
In medicine we often have a barrier between us + our patients. We speak as if we’ve had no experiences- no matter how similar they may be.
In mutually sharing stories, I felt more connected than ever before.
4/4
@JennaMillerKC
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Just had a scope done.
No clinician made eye contact with me in pre-op.
The anesthesiologist explained he was going to use propofol intra-op.
Then, he pushed versed without telling me he would be using versed. I had to ask what he pushed.
C'mon man... that's not how we do it!
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I’m at a loss for words when my grandfather’s geriatrician says that hospice only gets involved when it’s the last few days of life.
He’s 102.
There are DNR orders.
The goal is to stay home.
Hospice ≠ death.
Hospice helps to support a good + comfortable remaining life.
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Why do we call our patients’ parents “Mom” and “Dad”???
They are not OUR moms and dads.
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I'm not willing to place my own health on hold anymore.
I'm not willing to continue missing big life (and by default, death) events anymore.
I'm not willing to put my husband's needs below everyone else's.
I am actively choosing to be present in my life.
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My daughter is coming home from the NICU today!!!!!!!
Happy to close the door on this rocky beginning and ready for the rest of our life to begin 💕💕
#neotwitter
#PedsICU
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Me: Before we move on, I want to thank you for sharing your experience with me. This is the first time I’ve met someone in-person who’s had a similar journey.
I was moved by the interaction, profusely thanked the doctor for being open.
3/
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Why not try to bundle meds?
Why not try to bundle cares + meds?
Why do we need labs drawn so early?
Why is a 7A weight check necessary if there’s no concern for fluid overload or acute weight loss?
Let our patients sleep.
LESS IS MORE.
- a tired patient, mom and doctor
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Doctor walks in, we do intros + then an exam.
Doctor: Congratulations on your little one on the way. We also had our child via surrogate.
(Doctor shares more details abt their surrogacy journey + moves on to make a plan abt my care)
@arghavan_salles
@VSLanziotti
2/
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One of these turkeys is 100 years older than the other 🦃💕
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If someone said we’d be thriving 2.5 years after the NICU, I wouldn’t believe them.
So much gratitude💕
#neoTwitter
#pedsICU
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My husband + I attended a wedding last night.
Me: May I have a glass of Prosecco?
Bartender: Sure (wink). Would you like any cranberry juice with that?
Me (confused): No.
After a sip + watching kids get poured sparkling apple juice, I realized he gave me apple juice too.
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Had the pleasure of being a patient to a newly minted PGY1.
She was compassionate, thorough, humble, broke bad news with such delicacy, and was able to say “I don’t know.”
She makes me want to be a better physician.
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It’s a strange feeling to know you’re going home to your healthy child at the end of the day after bearing witness to the death of another parent’s child.
❤️💔
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Stranded in the airport for 6 hrs.
Thank you to:
- the strangers who let my kid look through their purses, take their keys + glasses
- the woman who kept a straight face when my kid asked if her fur coat was made of dog
- TSA agents who gave stickers
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My toddler: Mommy. I’m scared of doctors.
Me: But, I’m a doctor and I’m not scary.
Toddler: No. Not you. Real doctors.
😂 OK!
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Just had a visceral reaction when I heard a provider say, "This is an ex NICU kid with all the NICU problems."
After being a NICU parent, I have become hyper-aware of language we use to describe our patients.
Language matters. Think first.
#NeoTwitter
#PedsICU
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Today is my daughter’s 3rd birthday
3 YA today I received abt 30 units of blood products (thank you donors)
The surgery res placed a cordis while I was awake (thank u for ur steady hands)
The NICU allowed my mom to sit w/ my baby since I couldn’t (thank u for ur kindness)
1/
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It is *hard* to be present in the PICU while your son is in the NICU.
We MUST improve parental leave.
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@ALMannixMD
Yes-- I once (more than once) was not believed.
They said, "Do you have your doctor card for proof?"
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It’s insane to me that kids need to be sent out-of-state because the Chicagoland
#pedsICU
are at capacity.
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Clipping baby nails should be considered a HIGHLY TECHNICAL procedure.
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When my daughter + I went to our respective ICU’s after her birth, the team wrote her name on the whiteboard in front of my bed
On 1 side, they tallied the # of units of blood I received + when
It also had my name, the date and “Juniper Rose,” my baby who I hadn’t yet held
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Despite my best efforts, I was “gifted” the black cloud pin from the previously reigning black cloud
#PedsICU
attending
🌪️🌪️🌪️🌪️🌪️
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Last night my 101 yo papa thanked us for coming to visit. Then he said he felt sad at the thought of never seeing us again.
It was the 1st time he reflected on his mortality
An hr later he had recurrent TIAs (manifested as Wernicke’s aphasia- nonsensical stories abt red string)
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On a mother-daughter trip:
Mom: What's on your nightstand?
Me: Lexapro.
Mom: You need to take pills to get through the week with me?
Me: No. They're for the 18 years I lived with you.
(Real conversation. Half kidding. Postpartum depression is real. End the stigma💕)
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Juniper: Mommy, why are you going to work?
Me: I need to take care of some sick babies but I’ll be home tonight.
Juniper (sick at home): But mommy. I’m your sick baby. Why are you leaving me?
#womeninmedicine
😳🫠💔
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I think about the gesture often- it wasn’t just an erasable marker for me
It made the experience more personal
People who entered the room knew to use her name when they talked with me
Her name, in front of me, gave me strength. I think it helped motivate the team too
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I met my husband 4 ya today.
I love him more now than ever. He has shown love in ways I never imagined.
After the ICU, when I was too weak to stand alone, he washed my dysmorphic, fluid-overloaded body.
When I got out, he brushed my hair when I couldn't.
This is love.
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I exclusively pumped for the last 10+months. I take pride in this.
My milk production is falling + I feel like I am not enough of a mother.
Today, as I introduce formula, I immediately feel happier. I am enough.
Fed is best. End the stigma.
#WomenInMedicine
#PedsICU
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@CaseySeidemanMD
Recently heard a story about a family asking for ivermectin and the ICU doc said “You’re welcome to got to PetSmart and pick some up, but I will not be prescribing this.”
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My 2.5 YO looked at my 2 MO and said “We are going to be grownups together.”
And I lost it.
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Somehow my heart is filled with more love today than yesterday.
I didn’t know it was possible 💕
Pic below of our 2 NICU grads
#neotwitter
#pedsICU
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Palliative care is far from what I expected from fellowship
Palliativists are some of the most fierce advocates I've ever met
So lucky to be learning from this group. I encourage you to rotate or take a year to do extra training. Your patients will benefit from the experience
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It was insinuated I've been an absent mother (not by my partner).
Coming back to work after maternity leave is hard.
Being present @ home after a busy day is hard.
I love my jobs-- both @ the hospital + @ home.
I'm trying my best. I am enough.
#PedsICU
#WomenInMedicine
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My daughter has beautiful, tight curly hair.
She came home from daycare today, looked in the mirror + said “My hair is crazy.”
Someone must have said this to her and I can’t take it back.
Judgment about beauty is now starting before 3 years old and I want to scream.
💔
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Palliative care should be a mandatory rotation in
#pedsICU
, NICU + oncology training.
#MedEd
#neoTwitter
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“Will you be joining us for the Mommy and me sip and paint at 10 AM?”
It kills me to say no.
But, I’m a working mom.
I’m in the PICU taking care of kids who don’t get to be held by their own mothers.
I’m where I need to be.
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He’s alive today.
Had breakfast + road on the stationary bike this morning as if nothing happened.
I can’t help but wonder if he knows his time is coming soon.
♥️♥️♥️♥️
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Ok. So I met some Grey’s Anatomy actors!!!
When I explained I’m a fan + a doctor, Owen Hunt shook my hand and said “Wow, you’re the real deal.”
And I, reflexively said, “No, YOU are.”
^^ basically like telling the cashier “You too!” when they say have a nice meal.
😂☠️
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An attending openly shared her views on surrogacy- she didn’t understand it, couldn’t understand why people choose it (+ the list went on)
I too didn’t understand until we were told it wasn’t safe to carry again.
Friendly reminder: Families come in all shapes and sizes.
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@Adamhill1212
🤯
At 6 weeks postpartum (after an emergency CS, 11 uPRBCs, intubation) I was back working in the cardiac ICU while my daughter was still in the NICU.
My voice was still hoarse from being Intubated. My incisions were still healing.
6wks wouldn't be a thing if men had babies.
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NEW CONSULT:
Me: Have you told the patient you're worried they won't survive?
Them: No, that's why we are consulting you.
Me: ...
Them: ...
Data show we are uncomfortable with discussing uncertainty + death with our patients. We must do better.
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Please consider consulting palliative care > 5 minutes before someone dies.
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My dad stood outside the hospital w/ a sign saying “I love you” (no visitors allowed. Thank u for showing love)
My husband saved my life because he advocated (without u, I wouldn’t be here)
Thank you to my tiny, mighty, daughter who continues to give me strength every day.
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On my last night in the
#pedsICU
security called + said people in the lobby wanted to see me.
These were parents of a child on whom I had performed a brain death exam 1 YA.
They wanted to say goodbye, knowing it was my last night at Lurie.
It felt like closure, for both of us.
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Excited to share we are expecting a baby via surrogacy!
This piece feels important to normalize our family (and all those that take the path less traveled) as we navigate both grief + gratitude
💙💙💙
@JAMA_current
@JennaMillerKC
@VSLanziotti
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@drjay68
1) I am so sorry
2) HOLY COW!!!!
Why are people like this? Why do people assume the worst?
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My daughter just got moved from an isolette to an open crib!
^^ 1 step closer to leaving the NICU 💕
#Neotwitter
#Pediatrics
#WomenInMedicine
#PedsICU
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- every person w/ white hair who my kid stopped + asked if they were grandmas (men included)
-those who shared their potato chips, fries, toys + chocolates
- the gentleman who let my kid try on their cowboy hat
As they say: it takes a village. Thanks for playing along.
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@BoogieDownGal
Ha! The conversations! YES!
And yes, I’ve unfortunately been a patient in the SICU, a parent in the NICU and a doc in the PICU! 🫠
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My friend's 3 week old is intubated in the
#PedsICU
with RSV + COVID.
This is not an adult-only illness.
PLEASE protect those who can't get vaccinated.
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To the provider who examined me while wireless pumping:
I see you
I appreciate you
Your child will too
You walked into the room + didn’t comment on the soft hum at ur chest
You embodied what it is to balance work+ parenting
I’m sorry I didn’t tell you
You’re doing great♥️
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After 11 years of post-undergrad education + training, I am SO excited to be going home to Chicago to work at Advocate Children's Hospital
What a way to bring in the new year
🎉🍾🥳
#PedsICU
#pedPC
@pedspophealth
@ACHPRPICU
@vhavalad
@DeannaMarie208
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I appreciate all those who do know the hospice criteria.
I didn’t share his entire story.
He meets the US standardize-criteria.
The point is that his doctor doesn’t understand the criteria.
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There was a time 3rd trimester when I thought I'd get more sleep after I delivered our baby.
That was a cute thought.
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STAT pall care CS for a dying patient who's been admitted for > 2 mo is a disservice to the family
Rehashing the story + introducing a new team is not what this family needs
They need their primary team to listen empathetically, answer honestly + provide comfort-focused support
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Male feedback: If you don't speak louder or stand on a chair or stool during a resuscitation, nobody will believe you're in charge.
*incorporates feedback*
Female feedback: You're being too assertive.
CAN'T WIN!
#WomeninMedicine
#PedsICU
#AcademicTwitter
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The SICU team called me “Dr. Rissman” (thank you for acknowledging me as a person)
The OBGYN resident heard me say “I’m going to crump” and she believed me (thank u for listening to your patients)
The OBGYN team acted fast (thank u for recognizing HELLP)
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I’m overwhelmed by the amount of outreach I’ve received about this article.
When my husband asked why I continue to write, I said it’s so that I (WE) feel a little less alone.
I hope you feel seen.
You are good enough.
#pedsICU
@JAMA_current
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I write to cope.
I write to try to give a voice to those who experience the unexpected.
I write to try to make things better for the next patient, parent and clinician.
#Neotwitter
#PedsICU
#OBGYN
#WomenInMedicine
#MedTwitter
#MedEd
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Handed in my pager + badge today.
When I walked out the door, I was met with a bouquet of emotions as a stranger said, “Enjoy this glorious day.”
It’s like he knew.
Exhaustion, gratitude, pride, and peace.
I took a deep breath.
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@eleniengaged
While I don't wish illness upon anyone, there's nothing more educational than when a physician becomes a patient.♥️
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"I have to go pump" is ALWAYS followed by "Sorry!"
Sorry to my colleagues + patients for stepping away.
Sorry to my daughter for not being home.
Sorry to myself for associating an act of love with guilt.
#WomenInMedicine
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How can one be approachable and "more intimidating," "less girly," empathetic (but "don't show too much emotion"), give feedback (but "don't be too direct" or "condescending")?
Asking as a woman in academic medicine.
#doctor
#CriticalCare
#WomenInMedicine
#PICU
#pedsicu
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I did it.
A friend sent a pic of a rash.
My response: Gotta ask your PMD about this one. Ask me about breathing, acute heart failure, cardiac arrest, invasive infections and dying.
#pedsICU
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My husband has shown up to every NICU/PMD follow up appt for our daughter.
It's made me conscious of the mom-centered language (both verbal and nonverbal) providers use to address us.
It's important to recognize both parents and treat them as equal.
#PedsICU
#NeoTwitter
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I met my husband on
@bumble
After our first date, I told my mom I was going to marry him one day.
It was love at first swipe 💕
#ValentinesDay
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@pedsmd2b
I got this as a PGY7: “Does not always say when she is leaving or when she is no longer answering pager”
So everyday after, I texted the attending on service + my PD when I’d turn off my pager + then again when I left the building🤷🏻♀️
Unclear expectations are hard to meet.
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My daughter, Juniper, has made it 24 hours without apnea, bradycardia or desats!
Another step in the right direction 💕
#NICUmom
#neotwitter
#pedsICU
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I was lucky enough to spend Xmas with my family this year.
Over the holiday my daughter learned that if you point at things, they are brought closer (toys, food)
This morning when I left for the hospital, she sobbed + pointed at me until I left our front gate.
Im still crying.
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I just ran into the neonatologist who resuscitated my daughter.
Juniper, now almost 5X her birthweight, was in my arms sleeping soundly.
I thanked him for giving us such a gift. We wouldn't be a family without him.
#NeoTwitter
#PedsICU
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