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No Barriers Podcast Episode 134: Frontlines of the NICU with Benjamin Rattray



To introduce our guest this week, read you a passage from a recent essay he wrote: “I gaze at her straight charcoal hair, serious blinking eyes and flawless skin. She is only a day old, but already her muscles are tight and when she cries it is high-pitched and she is difficult to console. Her urine is positive for benzodiazepines, amphetamines, cocaine, and opioid derivatives.” These are the words of Benjamin Rattray. He takes care of babies in the neonatal intensive care unit. He walks the path where life and death are regularly held in his hands. He balances clinical science and compassionate care, with the goal infusing his medical practice with empathy and humanism. What does this all mean for us? Have a listen and discover for yourself. NOTE: This is our final episode of the year and our production team is taking a break for the holidays.

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Episode Transcript

Erik Weihenmayer:
It's easy to talk about the successes, but what doesn't get talked about enough is the struggle. My name is Erik Weihenmayer. I've gotten the chance to ascend, Mount Everest, to climb the tallest mountain in every continent, to kayak the Grand Canyon. And I happen to be blind. It's been a struggle to live what I call a no barriers life. To define it, to push the parameters of what it means. And part of the equation is diving into the learning process and trying to illuminate the universal elements that exist along the way. And that explored terrain between those dark places we find ourselves in and the summit exists a map. That map, that way forward is what we call no barriers.

Didrik Johnck:
Didrik Johnck here, No Barriers Podcast producer. To introduce our guest this week, let me read you a passage from a recent essay he wrote. "I gaze at her straight charcoal hair, serious blinking eyes, and flawless skin. She is only a day old, but already her muscles are tight. And when she cries it is high pitched and she is difficult to console. Her urine is positive for benzodiazepines, amphetamines, cocaine, and opioid derivatives." These are the words of Benjamin Rattray. He takes care of babies in the neonatal intensive care unit. He walks the path where life and death are regularly held in his hands. He balances clinical science and compassionate care with the goal of infusing his medical practice with empathy and humanism. What does this mean for all of us? Have a listen and discover for yourself.

Jeff Evans:
Greetings, No Barriers community it's Jeff and Erik here with our guest, Ben Rattray. I think I pronounced that right, Ben. Did I get it right?

Benjamin Rattray:
Yep. You got it.

Jeff Evans:
Rattray. is it an emphasis on tray like on the end?

Benjamin Rattray:
Yeah. It's Rattray.

Jeff Evans:
Rattray. Okay.

Benjamin Rattray:
Yeah. It's Scottish and there's not too many of us.

Jeff Evans:
Ah, I love it. It's very phonetically appealing. So Ben is a big underachiever. The simple introduction for Ben is he takes cares of babies in the neonatal intensive care unit. The bigger story-

Erik Weihenmayer:
He takes cares of babies?

Jeff Evans:
Yeah. He takes cares of babies.

Erik Weihenmayer:
Is that how you started this out?

Jeff Evans:
... in the ICU. Yeah. So there's certain people who go into medicine, and just kind of plug away. And then go into like, I'm just going to be an ER doc. And they take the simple route. Ben, on the other hand, goes to Duke. Which I can give Ben a little bit of grief about it. I'm a Tar Heel through and through. But all the smart people went to Duke. All the not so smart people went to Carolina.

Jeff Evans:
But so for those of you who are not in medicine, most people, most docs, PAs, nurse practitioners get board certified in a specialty. Ben decided to get double board certified in pediatrics and neonatal perinatal medicine.

Erik Weihenmayer:
And an MBA.

Jeff Evans:
And he's got an MBA. Yeah. The dude is a hard charger. And we're very happy to have him on here and talk about his experiences. Currently, he lives in, you live in Greensboro still right now?

Benjamin Rattray:
Right. Yes.

Jeff Evans:
Yeah. And works in the Cone Health, which is in Greensboro with his family there in a good part of the world. So Ben, thanks for joining us today. We're really excited to talk to you and hear more about some of your experiences.

Benjamin Rattray:
Thanks so much for having me on the show.

Jeff Evans:
Well, and you just came off of a overnight unit shift, which, once again, I can attest is not an easy deal. It's a physical and mental grind. And then you get home after this physical, mental grind, and then-

Erik Weihenmayer:
Straight to a podcast.

Jeff Evans:
Well, then you take a nap, right? It's not restorative sleep necessarily. It's like you just basically turn your brain off, go straight into REM for an hour or two, and then come back up and start slamming coffee.

Erik Weihenmayer:
How many hours have you been awake?

Benjamin Rattray:
I've been awake about three. I slept about three after I got home. Woke up, had a couple cups of coffee, and I'm ready to go.

Erik Weihenmayer:
You're ready for action.

Jeff Evans:
Do you have to go back in tonight or tomorrow, or are you off?

Benjamin Rattray:
No, I actually have tomorrow off. And then I'll be back in for the next night.

Jeff Evans:
Well part of what we're going to talk about today is you're in a very heady arm of medicine. I think maybe every arm is probably heady in its own right. But I've always thought, I'm an emergency room PA, and I've been for 20 years. And I always, when a patient would come in, there was three things I would try to avoid. I didn't like burns for whatever reason. I didn't like feet. And I didn't like little tiny babies. Because all three of those things kind of freaked me out because there is so much going on with pediatrics, especially the neonates. And so you-

Erik Weihenmayer:
A baby can't talk to you, and tell you what its problem is.

Jeff Evans:
There's so many nuances to it. So I mean, Ben, I guess what prompted you to go that direction? And was there something that sort of cued you early on in your medical career? Did you know it, or sort of did it know you and pull you?

Benjamin Rattray:
Yeah, so I actually thought I was going to do neurosurgery. That was what I was really focused on in medical school. And I was actually all kind of set up with a program, but I actually ended going doing a neonatology. We call them a sub-internship. Where as a medical student, you get to go in, take care of a couple patients, and just kind of get a feel for that specialty. And I really, really enjoyed it. And so that actually made me want to go into do a pediatric residency, knowing that I could then springboard into neonatology after that.

Benjamin Rattray:
So yeah. So in my pediatric residency, I had times where I was kind of wondering if maybe I would do pediatric ICU, pediatric ER. But really I feel like neonatology really found me. As soon as I stepped foot in the unit, it was kind of this mixture of coming home, but also feeling terrified. Because you're just so terrified that you're going to accidentally pull a breathing tube, or dislodge a line or something like that. But I really loved it. I loved kind of the immediate stuff that you can do. You can resuscitate a baby in the delivery room, you can make these immediate vent changes. You can do everything really quickly. But you also have this continuity with babies and with families over time. Some of our patients will stay with us for three months or so. So it's this really kind of unique mixture of all of those different components.

Erik Weihenmayer:
Ben, so being a neonatologist, it's like you hear about the Oscars and they give each other awards and stuff, but I don't think I've heard that term very often. So it just makes me wonder, and a book like yours coming out bringing to life this field. I feel like it's a little bit invisible. Is that true? You know what I mean? Do you feel like, and I know you didn't go into this for attention and so forth, but like it's an area that maybe doesn't get enough attention and love.

Benjamin Rattray:
Yeah. I totally agree with you because I think most people come into the hospital, they go onto the labor and delivery floor, and then they go onto the mother baby floor and they go home two or three days later. And they don't realize that there's a whole floor of the neonatal intensive care unit. They have no reason to really know that we exist. And so a lot of people really don't realize what we do. And it's interesting too, because sometimes people will kind of make a comment like, oh, you work in the NICU. You get to work with all the little babies. That must be so amazing. And it is. But I think it kind of shows that they're not quite realizing kind of some of the intensity and complexity that goes into taking care of those babies. So I think you're right. For the people that obviously get that exposure, they learn all about it, but for a lot of people, they just don't realize that we're there.

Jeff Evans:
Yeah. There's almost like, any unit. I mean, I'm sure most listeners have probably either been in a unit or visited a unit at some point. And I'll tell you, whenever I used to round, it was always that was the smartest nursing staff and the smartest internists and specialists were always around the unit, because there's just so much happening. For instance, in the emergency department, we've got three, four, five patients at any given moment. I know as an attending there, you've probably got more. But a unit nurse would have one patient, right? Maybe two, right? It's just that intense. Am I right there?

Erik Weihenmayer:
And overall, half a million babies admitted into the neonatal intensive care-

Benjamin Rattray:
Yeah, that's right.

Erik Weihenmayer:
... a year. And is that in the United States?

Benjamin Rattray:
That's in the United States. So there really are a lot of babies that come through. Yeah. And those nursing ratios range from one to four. So it kind of depends on how complex the baby is. But yeah, sometimes it's just a one to one ratio. If the babies are working more on feeding and kind of growing and getting closer to going home, it could be a one to four ratio. But yeah, they're pretty small ratios.

Jeff Evans:
Yeah. And so then there's this other little aspect. If getting an MBA and getting board certified and two specialties wasn't enough, turns out Ben's an amazing writer as well.

Erik Weihenmayer:
Yeah. Beautiful, beautiful writer, Ben.

Jeff Evans:
Yeah. And so he's got a new book, When All Becomes New, which I think we'll get to. But initially just to get a flavor of your writing, I read the article that you wrote. And let me see if I can figure out-

Erik Weihenmayer:
Is that about the crack, the baby... Oh, not, excuse me, crack. I shouldn't say that. It's the baby born on different kinds of drugs and so forth. Because I read that one, and I read the one where you talk about how you connect with families.

Jeff Evans:
Yeah. It was connecting with families. And I mentioned offline to Ben that I know with the intense interaction he has with his patients, and then ultimately, maybe even more so than other specialties, with the families of these babies. That there's this indelible just fingerprint that's left on your consciousness. And the article that you wrote about, it's really kind of framed with that. Just how impactful and memorable a lot of these experiences is. And then the metaphor of you resuscitate this one baby, and then you can't get the blood off of your shoe, right? It just lingers. So that was my first taste of your writing. Take us into that. I want to know sort of what your stream of consciousness was when you wrote that, and what that's like for you. And then we'll kind of move on to just the writing in general.

Benjamin Rattray:
Yeah. So that article was about my brown pair of shoes, which I'd worn in a delivery where we'd had to resuscitate a baby. And really it was just a couple of drops of blood that ended up on my shoe. We ended up bringing the baby up to the NICU. Actually dropped the baby's body temperature for three days to try and protect the baby neurologically. And the baby had a really great outcome. But I found myself sitting on the driveway after the baby went home trying to get these drops of blood off my brown dress shoes. And I couldn't do it. I scrubbed them with a wipe. I ended up putting some shoe polish. And those drops of blood are still on my shoes.

Benjamin Rattray:
And I think that what metaphor for me was exactly what you were just talking about. These babies and families leave a mark on us, leave a mark in our memories. And we just always remember them. And it's kind of like those drops of blood. They'll never go away. And I think that's really what makes medicine what it is. We have these really intense encounters with people, and it changes us. I'm definitely not the same person. I don't see things the same way that I did before I started in medicine.

Jeff Evans:
How so are you more hardened? Are you more jaded? Are you more compassionate? All the above?

Benjamin Rattray:
Yeah, it's actually, I think I'm a little softer over time. I think when you start out, everything's sort of black and white. You're really focused on the objective parts of medicine. You're trying to get the right diagnosis, trying to get the right ventilatory settings. And I thought that to protect myself I really needed to have that distance from patients. Kind of knowing that over time, it kind of, hopefully, a long career, and needed to protect myself. And I think what I've found actually is that it's actually the opposite. We really have to draw near to patients and that's what's protective is we build up those relationships and form that connection.

Erik Weihenmayer:
So that's really fascinating that you say that. Because I kind of think about my own interactions with a doctor and when I'm feeling in pain or sick or worried about something. There's this balancing act with your doctor. I kind of wonder, do you want your doctor to be vulnerable and compassionate, or do you want them to be like the iceman who just kicks butt and does a great job on the surgery, or whatever it is. And is a superhero in a way, has an armor around them so that you can sort of feel like there's hope and you're in the hands of this superstar. Does that make sense? It's a really tricky balancing act, I would imagine, as a human being in this role.

Benjamin Rattray:
I think that's right. And I think the goal is to have agility so that you can do the technical aspects when you have to. So for example, if I'm in the delivery room trying to get a breathing tube in a baby that weighs a little under a pound, that's the time for me to sort of disconnect emotionally and just focus on getting the tube in. Because if I'm standing there kind of thinking about what the parents are thinking, or starting to worry about what if we can't get the tube in, and then I have to tell the parents that we couldn't get the tube in, how is that going to be? That's really the time I think-

Erik Weihenmayer:
It's a rabbit hole, right?

Benjamin Rattray:
Yeah, exactly. You can really start to kind of psych yourself out. So you really have to just focus on the technical aspect. But then the really tough part, I think, is to be able to shift back and forth. Because once the tube's in and the baby's stabilized, you have to be able to kind of then shift so that you can talk to the parents and have a lot of empathy for what they're going through. And so, yeah, trying to build that agility is challenging.

Jeff Evans:
Yeah. You're a hybrid. You're an iceman Oprah hybrid. You're like clinically tight, and then you can pivot over to loving, compassionate.

Benjamin Rattray:
Yeah. Except I'm not really that good. But yeah. I think that's the goal.

Jeff Evans:
My guess is you probably are to be able to do what you do. When I got into emergency medicine, I read a book called the Blood of Strangers, Huyler, or Huyler or something is the... And it marked me. I remember reading it, and it was all just about encounters that we have, very similar to what you wrote about. About how that blood metaphorically just sort of resides in us. And these are strangers until they're not, and then they become a part of your tapestry of your life to a certain extent. I mean, I know the answer to it. I just want to hear you riff on it. But how has it impacted you as a husband and a father and a member of your community?

Benjamin Rattray:
Yeah. I think it makes you more appreciative. When you see all these really difficult situations that people are going through, it makes you kind of come home to your family and be more appreciative, try and live in the moment a bit more. Which is tough right now because there's a million work emails and texts and all sorts of things that you're trying to juggle. But when you see people in these really difficult circumstances, you realize kind of what's important in life.

Erik Weihenmayer:
Back up Ben, and tell us like the challenges that babies come in to the intensive care with. What's the gamut? And obviously it's training to make these split second decisions, these decisions that are life and death decisions without any time to spare. One of your articles talked about running through the hospital trying to get this baby that wasn't breathing.

Benjamin Rattray:
Yeah. So there's a lot of different reasons for babies to come into the NICU. I mean, of course one of the more common reasons is prematurity. But then also there's babies that have birth injury, basically a difficult delivery that impedes the blood flow. Some babies have respiratory issues just with fluid in the lungs. Genetic conditions, infection. So kind of a whole host of issues. And some of those are really emergent. So for example, especially the delivery room situations, where it's either a preterm baby who suddenly delivers, or a baby who sort of gets stuck on the way out and has to be resuscitated. So those kind of situations are really emergent. And then other times we actually have a pretty good kind of knowledge that a mom's going to have a C-section, and it's going to be a preterm baby. And then we have plenty of time to kind of get all our gears set up, and we're just ready and waiting for the baby.

Erik Weihenmayer:
And you mentioned that idea resuscitating babies. One of your articles, the baby wasn't breathing for eight or nine minutes, and it's gone. And then you bring it back, him, her, back to life, starts breathing, blood starts pumping through its body. Oh my God. What are you thinking at that time? And then the second piece of that is you talk about whether it's worth bringing somebody back to life. Because you don't know if they're going to have really bad traumatic brain injuries. And it's like this mist that is an elusive mist that you don't even know what the line is. Some kids will come back totally normally and some won't. It seems so mysterious.

Benjamin Rattray:
Yeah. That's the hard part because it's not like there's a fixed time that is the same for every single circumstance. So you can have some babies that, like you're saying, may go for eight or nine minutes, but then we're able to effectively resuscitate them and have a really good outcome. But there are also some babies that may have that same length of time that end up with profound brain damage. So not only is there that kind of uncertainty, but there's also the uncertainty for each family about what they're wishes are. So there's some families that want to take a baby home no matter what. And then other families that really do not have that wish. And the difficulty is you just don't have time to kind of talk about those things in that situation.

Jeff Evans:
Yeah. Because it's not like they did a advanced directives or a DNR or something with a neonate, right? So the other thing that's really, I think, for justifiable reasons, there's a lot more intensity around a fragile baby and the resuscitateability of a little one as to a grown ass adult or an elderly patient. Where everybody's like, well, let's do what you can, and everybody's very intense. But we value a younger life more than an older. That's just a fact, right? So there's just so much more on your shoulders societally, and then of course medically.

Erik Weihenmayer:
Yeah. So working with babies, do you bring them back no matter what? Like as a doctor, your prime objective is to bring life no matter what. Or is there a point where you have to say, I just don't think this is going to happen? I mean which is, I mean, so understated to even talk about it in that way.

Benjamin Rattray:
No, you're right though. Because there you do get to that point where you say, I really don't think that the quality of life is going to be such that we should continue. So for example, we were resuscitating a baby who was born right on the cusp of viability at 23 weeks. Weighed about a pound, and was born without a heart rate. And so we started our resuscitation. Put it in the breathing tube, gave a number of doses of epinephrine, but still didn't get a heart rate. Finally we kind of got to that 10, 12 minute mark. Had a heart rate of about 20. Gave another dose of epinephrine, and the heart rate didn't budge. And so we got to that 15 minute mark with a heart rate that was just barely detectable. And at that point, just like you're saying, we knew that we really couldn't effectively resuscitate this baby and get this baby home with the parents. So at that point made the decision for mom to hold the baby. That was the most compassionate thing to do at that point.

Erik Weihenmayer:
And on the other hand, you have that baby that you wrote about with nine minutes of not breathing. And you go through all the therapies and so forth and do an MRI later on, and he's normal. He's totally normal. No detection of a brain injury.

Benjamin Rattray:
Yeah. That's the amazing thing. We see such a wide array of outcomes. And then we have some babies, for example, that need less resuscitation, but have some markings of injury, and go on to have disability in the future. So it makes it really difficult to predict what those outcomes are going to be.

Jeff Evans:
And what I'm interested in as well, Ben, Greensboro's a decent size city, but how long have you been practicing there at Cone? How long have you been in there?

Benjamin Rattray:
I've been eight years at Cone.

Jeff Evans:
Okay. So now there's plenty of kids who are now eight years old that are playing soccer in Greensboro and kicking around that you, clearly, you saved their lives. You provided an opportunity for these kids and these families to go on. So does it ever happen where you get that continuity and see these little ones who are now growing up and are a viable part of their community?

Benjamin Rattray:
Yeah. Yeah. So one thing that I'll definitely point out, too, is it's such a team effort. Neonatology is such a team sport. So it's just the whole community that makes that happen. But you're right. One time, I was at my son's soccer game, and this little girl ran up to me. She was about five. And I had taken care of her in the NICU. And I had spent a lot of sleepless nights worrying about her. She's actually in the book. And yeah, I mean, it was stressful. We were worried at one point that she had a bowel infection, and that she would lose a lot of her bowel. Thankfully, that didn't happen. And she was wearing this little white dress and she just ran up at the soccer game. And I mean, those kind of moments, they're kind of few and far between, but they're magical when they happen. Because you just sort of have this feeling of like, wow, I was so worried about this kid, and she's beautiful.

Erik Weihenmayer:
And you have those highs and those lows. You're making these split second, in a way, decisions of life and death. And I mean, I don't want to overexaggerate, but I compare it to people in a war zone. So I wonder how you survive as a doctor in that situation without having PTSD, without having some kind of trauma where you're constantly wondering did I make the right decision? Did I make the right call? How do you build your mindset to be able to move forward and be a healthy and to vigil? Or does every doctor in your situation have mental health issues?

Benjamin Rattray:
Unfortunately, there definitely are mental health issues in medicine. You look at the suicide rate as higher. Whether it's because people are type A, or because of kind of bearing witness to some of these things. For me, it's turned out to be really helpful to write. It's my way of sitting down quietly, reflecting on the different situations, trying to put words to some of the thoughts. I definitely like to be outside and do active things too. I find that when I'm hiking, I can start to kind of process some thoughts as well. I know for a lot of people too, it's kind of community and talking about things.

Benjamin Rattray:
But one of the things that I've definitely noticed for us is that we generally don't talk about these things. So we could have a code situation. Everybody walks out. We'll do a debrief, kind of talk quickly about did we do the right things? Did we give the right medicine? Those kind of things. But generally speaking, we don't really talk too much about how it affects us emotionally. And that's one of the really amazing things for me about writing and about reading. So for example, I know that you interviewed Rana Awdish previously, and I read her book In Shock. And for me, that's just an amazing opportunity to kind of see how she feels, how she sees the world, how she deals with things. And that's a really important thing for me.

Jeff Evans:
Yeah. But in M&Ms and so forth, for a post code or something, yeah, you talk about the technical aspect, the iceman aspect. You don't talk about the Oprah shit, right?

Benjamin Rattray:
That's right. That's right. No way.

Jeff Evans:
It should be a component of it. Because, I don't know, when I went to PA school, it was just, it was like you said, it was just clinical, clinical, clinical, clinical. And that's a miss, especially now, right? Maybe even more so than ever because the burnout within the medical community is so high right now. I feel like hopefully we are at least accommodating that. Are you finding personally within your staff, are you making it a topic that can be addressed, or does it just kind of have a slow burn to it?

Benjamin Rattray:
Yeah. I mean at the moment are not necessarily addressing it. It's been interesting because definitely people in the unit have been reading the book. And I've got that feedback like, "Wow, I didn't know that you felt this way. I can identify with this." So yeah. I mean, I think it's something, especially in medicine, that we're going to move towards this time goes on.

Erik Weihenmayer:
To be able to get some counseling, or even some therapy perhaps, right? To be able to talk to someone. Or would doctors just be too cool for that?

Benjamin Rattray:
No, I mean, I think people definitely would do it. I mean, it's tough to talk to your family about it. And you can do it to some extent, but sometimes I think it's good to talk to somebody outside of the family.

Jeff Evans:
I want to talk a little bit more about your writing. You said you've used it as a tool. And I think Erik and I can both really appreciate that. Am I right in just guessing that just based on, this is a collection of some of your anecdotal experiences in the NICU, and then the human side of that? It's more Oprah than iceman. It's life, love, and loss, right? So did you, through your training, and then into your work at Cone, did you just jot down stories as you went? This was a heavy case, and then maybe a month later, this was a heavy case. Then all of a sudden, did you have a collection of those? Or was it a I'm going to sit down and write a book?

Benjamin Rattray:
I actually just sat down one call night in front of a blank Word screen and started writing down a story that was just really weighing on me. Kind of initially with the thought that maybe I'd share it with my kids when they were old enough to read it. I could share it with my wife. But then I ended up just writing and writing. And I realized I had all these stories that had accumulated over years. So basically I was just writing from memory. And then as I was writing the book, a couple more stories came up, and so I kind of started to write those down as well.

Erik Weihenmayer:
That's really important. A lot of people get a lot out of that. So in one of your articles you wrote about this baby who, the mom gives birth to the baby. You do a urine test. It's riddled with drugs, even syphilis. You find out it's her fourth baby, and boyfriend's in jail, perhaps. I'm just wondering, as a human being, is it hard not to be a little bit angry, or disillusioned, and go, God, what are people thinking? Or I'm just so disillusioned. I'm so overwhelmed by this problem in society.

Benjamin Rattray:
I remember in that case, and in a lot of cases like that, you sort of have this kind of push pull. Because for her, I was kind of looking at her almost like she was one of my daughters, and thinking about how difficult it was that she ended up in this situation. One of the ways that that I think about drugs, kind of rightly or wrongly, is I think that once you start, it's so difficult to stop. And then it just completely overtakes your life. And so that was what had happened in her case. And it was like one thing led to another, and it was this really difficult downward spiral for her.

Benjamin Rattray:
But then you also feel like just sort of a sense of helplessness because there was really nothing that I could do to help this mom. And I was sure that over time she was probably going to get sicker and sicker. She'll probably end up with a heart infection from the IV drugs, and she's in these really dangerous social situations. And knowing that we were going to send this baby to foster care, the mom was going to get discharged. And I really didn't have a lot of hope for the outcome. Which it's really hard because you feel like when you're in healthcare you should be able to help and you should be able to step in and do something really amazing to help somebody.

Erik Weihenmayer:
Do you think that leads to some burnout for people? Because I mean, I know a doctor who worked in an emergency room, and he just said, "The same people coming in over and over and over, and I just never felt like I made an impact." He got out of the business. He teaches college now. So do you see that a lot?

Benjamin Rattray:
Yeah. No, I think we do. I mean, I think people get really burned out and frustrated. Frustrated with the system and frustrated seeing, especially in the emergency room, seeing the same patients over and over again. Seeing the same kind of circumstances that you can't really step in and completely change them.

Jeff Evans:
I remember so many night shifts, just like 2:00 or 3:00 in the morning just feeling like I was handcuffed. I wish, I want, and we here we are the most advanced nation in the world, and our healthcare system, it's not a surprise, it's fractured along the way in a lot of different ways. And I remember feeling so many times just what you're saying. I know the resources are there. Or if they aren't, they should be. And how do I help this person? This person needs help. And in your case, whether it's the mom, it's the dad, it's the family system. You're bringing child protective services or whatever it is. But I'm sure you have felt that you've done everything right clinically, and then still there's this fracture.

Benjamin Rattray:
Yeah, that's right. I mean, that's one of the beauties of your organization, No Barriers. Reading the stories about what you guys are able to do. Providing so much hope and encouragement for people in ways that the healthcare system really can't do.

Erik Weihenmayer:
Well, you mentioned hope and faith a lot in your writings. And I kind of thought to myself as I was reading some of that stuff about hope and faith, what kind of hope and faith is it? Because, I mean, as a doctor, the stereotype is that you hang your hat on data and research and science. Where does hope and faith come in to the program?

Benjamin Rattray:
Yeah. I mean, it turns out, at least for me, it's a huge part of it. Because you're right. I mean the medical decisions are based more on kind of the objective data that we have. But those personal connections and relationships that we have, and also just kind of the resolve to keep doing what we're doing, I think it has to be fueled by hope and faith that you can make an impact and that you can benefit families. You can draw close to them and that what you are doing is worthwhile.

Jeff Evans:
So you knew when you wrote your book that the staff around you would read the book, right?

Benjamin Rattray:
Actually, no. I didn't think they would. I thought that they would think it was boring. I kind of figured that it's what they do all day every day. So I didn't expect anybody in the unit to read the book. And it's turned out that the nursing community has been a huge support. And that was a real surprise. And then the other thing too is I've told any NICU parent don't read the book. If you have a kid in the NICU, don't read it. If you've gone through it, it may kind of cause some PTSD. And I've actually been a little bit wrong about that too because I've definitely had a lot of parents that have found it really helpful and have read it. But I would still tell people, especially if you have a kid in the NICU, I wouldn't recommend reading it.

Jeff Evans:
Like present tense, maybe-

Benjamin Rattray:
Correct.

Jeff Evans:
... let's wait until you're discharged and home.

Erik Weihenmayer:
Right. Wait till your baby's healthy.

Jeff Evans:
Because then you get the life and love as opposed to the loss maybe and the fear of that.

Benjamin Rattray:
Yeah, that's right. Yeah. Yeah.

Erik Weihenmayer:
Ben, I have a technical question for you because Jeff does a bit of kayaking. I kayaked a ton for 10 years. And sometimes people flip and they drown. They're gone. And they'll be resuscitated out of cold water, and some of them are normal. Again, like you were talking about in some of your articles in your book. This mammalian dive reflex. And you talked about hyperthermia therapy. That's really amazing that that's a therapy that can be used to help the brain improve and heal. Explain that a little bit more for us.

Jeff Evans:
Look at you smart guy over there using those big words and stuff. Wow.

Erik Weihenmayer:
I know. Yeah. I pretend to be smart an hour a week.

Benjamin Rattray:
So one of the stories in the book, I actually talk about this. So this thing that I heard about, it was actually during the war in Iraq, where they were finding that if there were food vendors present when there were big crowds, the crowds would kind of eat, stay gathered as a big crowd, and there'd turn out to be a lot of rioting. And so I was kind of thinking that, in a way, therapeutic hypothermia is sort of like taking the food away from the crowds. And essentially what you're doing is you're kind of slowing down that metabolic rate. Taking away some of those free radicals that get that get formed. And essentially just kind of cooling everything off, slowing it down, so that you don't have increased injury. And you're right. That's exactly where the therapy came from actually is from cold water drownings, and seeing that some of those outcomes were much better certainly than the warm water drownings. So they ended up doing a ton of studies and actually were able to apply that to infants.

Erik Weihenmayer:
Wow. So is it safe to say that a baby's brain is so much more malleable and nimble than an adult brain, that it can have a lot of damage, and it can still recover?

Benjamin Rattray:
Yeah. To some extent, that's true. I mean the therapeutic hypothermia is best for the more moderate cases. If it's a severe case of brain injury, then it's much less effective. So I think it's true to a degree, and it's definitely true relative to an adult brain.

Jeff Evans:
I'm always interested in people like you, Ben, that are absolute hard chargers in a lot of ways. And you obviously balance a very complex professional life, and then you've got your family. And what made me think of this was induced hypothermia. Are there any life hacks that you do. Nowadays it's all the rage to dunk yourself in cold water and get super, super cold. Are there any breathing? I mean, something beyond just putting some some vegan powder protein supplements in your smoothie or something. Is there anything else you do?

Erik Weihenmayer:
Or putting shoot polish over the blood on your shoes.

Benjamin Rattray:
Right. No, I have to say I'm pretty boring. No life hacks. I am a vegetarian. But I don't do protein powder anything like that? No, I'm pretty boring. Basically just try and get enough sleep when I can, eat healthy, try and get outside as much as possible. But nothing too extreme or exciting.

Jeff Evans:
Okay. Well then knowing that, if you were at some point presented an opportunity to do a submersion into a ice cold tub, knowing that it would regenerate on the molecular level, the mitochondrial level of your body, and all of a sudden you'd come out looking 10 years younger, would you do something like that?

Benjamin Rattray:
Yeah. I mean, if it grew back hair, I think I would. I think if it could get rid of that receding hairline. Sure.

Jeff Evans:
Erik needs to do that too.

Erik Weihenmayer:
No. Hey, my hair's growing back. I'm getting younger.

Jeff Evans:
Propecia.

Erik Weihenmayer:
This isn't a question, but it's something I was thinking about when I was reading your writing. The idea that just recently I did this project with this lady, she's got a really bad brain injury, through our No Barriers organization. At five years old, somebody hit her with a ski. I mean a ski went into her brain. And it was a big question for them. What's her quality of life going to be like. The doctor struggled with this I heard in the film that we made. And they ultimately decided that they had faith that the quality of life was going to be good enough to resuscitate her and try to heal her.

Erik Weihenmayer:
And she lives fairly independently. She's got some caregivers. Her mom's a caregiver. But she lives independently. She works at the farmer's market and sells different things. She rides horses. She'll tell you what she thinks. She lost her filter in a way. So she'll curse you out. All the things you think and don't say, she says them. But ultimately her family and her community decided that she does have a quality of life that is worth saving. What's your mindset there? What's your philosophy there as a doctor?

Benjamin Rattray:
Yeah. I think it's so up to the family really. I think that everybody has a different sense of that. And it's a really difficult question to ask or to answer. Because in my case, it's the family that's going to bear the burden really for the rest of their lives.

Erik Weihenmayer:
Not you. Right.

Benjamin Rattray:
Exactly.

Erik Weihenmayer:
Makes sense.

Benjamin Rattray:
Right. So I feel like more than anything, we want to involve the family as much as we possibly can in all of these decisions. But I also certainly have the personal feeling that life is worthwhile, and that people can have an amazing quality of life despite a lot of challenges. But ultimately I think talking with the family, being as realistic as we can, and kind of guiding them through all the different situations. I mean, I think that that's our role in all of this. In the past, there was more of the medical staff would say, okay, this is what we're going to do. And they would make those decisions for the family. We're really getting away from that now. We're just trying to be the best guide that we can be and bring people through the circumstances.

Jeff Evans:
Well, there's a lot of subjectivity and objectivity we with the Hippocratic oath. I mean, it sounds like it's just like do no harm. Oh, well, there are some big decisions. And I think Erik and I have seen in our very subjective lives with our experiences in No Barriers that there are plenty of people who perhaps as children, as infants or young adults, who were counted out and were probably sort of kicked to the side and clearly were put in that category of non-contributing to society kind of deal.

Jeff Evans:
And then what happens? Then they emotionally, spiritually, physically get resuscitated, and find traction. And so you're at the beginning of that chapter in a lot of ways, right? For a lot of these eventual adults that find, and perhaps they've got cerebral palsy, perhaps they've got some issue that affects them either physically or emotionally. But yet assuming that the family understands kind of what they're going to get into. I mean, we've seen so many anecdotal real life experiences of that happening, of real transition to contribution. So I know that we know from our personal experiences that that's a fact, right? That is an absolute fact.

Benjamin Rattray:
Yeah. And I think too, there's a huge amount of value for families in taking home a baby, even if it's only going to be for three or four months. So say, for example, in some of the genetic conditions, the length of life is projected to be short. But we're able to get the babies home with the families with some feeding support, maybe a feeding tube. And they get that quality time with their baby for three to four months. And there's a huge amount of value in that as well.

Erik Weihenmayer:
This is a more philosophical question, but in your life you've done a lot professionally. Your a dad, your a family member, a community member. What do you think, if you had to point to the greatest barrier that you've broken through and pushed through and really felt good and proud like I got through that, what would you say it is for you in your life?

Benjamin Rattray:
Yeah. So I think it's two things. I mean, the first thing was to become a physician, which was a really, really difficult process. Getting into medical school, and then getting through the training was just a huge hurdle for me. You're looking at sort of 80 hour work weeks, and just a lot of stress and pressure. So that was the first big thing. And then actually the second thing was getting published. The book took me six years from start to finish. A year of that finding an agent, and a year of that finding a publisher. I've had more rejections in the writing process than I can count, probably 70 plus rejections from agents, and probably an equal amount from publishers. So for me the fact that I'm on this podcast today with a published book that people are actually reading some of the words that I'm writing, is just I can't even believe it really.

Erik Weihenmayer:
The naysayers, what were their rejection letters around? You're a no name, or nobody will get this, or it's too dark, or what?

Benjamin Rattray:
Yeah, it's all of the above. Some people didn't like the writing voice. Most people just didn't think it would sell. It's not a beach read really. Actually, funny enough, on the Amazon reviews, someone took a picture of the book at the beach. So maybe it could be a beach read. But I was kind of joking around and thinking I should have written a romance book or something. Because a book like this is more difficult to sell. And then some of the stories are really difficult outcomes, but a lot of them are amazing outcomes and really celebrate some really great things that happen. So it's sort of up and down.

Jeff Evans:
Do you think that some of the folks who may gravitate towards reading the book have been parents that maybe did go through, I know you said you wouldn't recommend that, but are you hearing that that's the case, and maybe it was a way for them to sort of reconnect with that time and that experience?

Benjamin Rattray:
Yeah, I think that's right. And I think for some people it's important for them to hear how much we care. Because hopefully that comes through in the book how much we care and how hard we work to try and get the best outcomes that we can. So I think that helps. And then I think too just, yeah, hearing the perspective of a physician, I think it can be really helpful.

Erik Weihenmayer:
And if you think of your life as kind of a mission driven life, which I can't imagine it's not, what's your hope for the future in terms of neonatology? I can't even say it, I'm so dumb.

Jeff Evans:
You sounded so smart up to now.

Erik Weihenmayer:
I know. I sounded so smart, and it all fell apart. In terms of your profession, in terms of your industry, in terms of maybe even healthcare in general in the US or in the world.

Benjamin Rattray:
Yeah. That's a huge question right now. Because of course we're going through such a big shift right now. Yeah. So there's sort of like my own personal hope, which is to be a servant leader. To take the time to hear other people stories, to listen with empathy and compassion, and to kind of tell these stories in a way that brings healing and connection. And then I would also hope a similar thing within the medical community. I mean, I think we're kind of struggling with the business of medicine right now and we're struggling with a huge amount of burnout, a huge amount of dissatisfaction. Both on the part of the patients and the healthcare providers. And so my hope is that somehow we can bring in some of these things, we can tell each other our stories. We can listen, we can have compassion and empathy, and we can change our encounters with each other.

Jeff Evans:
I think it's important to have narratives that are written first person from healthcare professionals right now, perhaps more than ever. Because I feel like there's such a split in so many factions of our society. And in a way I think medicine has been grouped, justifiably so, with science. And then there's there's this sort of baked in hesitancy and maybe skepticism of science. And what gets lost in that, and maybe in the past two years throughout the pandemic, is how hard and compassionate healthcare professionals have been working and putting themselves into it. Whatever it is. I mean, dentistry all the way up to working in the NICU. And I think it's critical to have that first person, hey, I care, I love, I'm compassionate, and I am a servant leader above and beyond all.

Benjamin Rattray:
Yeah. I mean, that's really kind of what I hope comes through. Because you're right, there's been so much division especially over the last two years. And that's really hard, I think, for everybody. It's hard for patients and it's hard for healthcare providers. You really don't want that animosity in the relationship. And so the hope is that as people read these first person accounts, you kind of cut through some of the politics, some of the objective things, and you just get to kind of hear somebody's narrative story. And I think it really brings people closer.

Erik Weihenmayer:
Have you had some really joyful moments where people talk about the book and relate to it and connect with it? Say like, yeah, that changed me?

Benjamin Rattray:
Yeah. I mean, that is just the most amazing thing because when I was writing the book and just going through, just slogging away at the sentence structure, and just getting to that point where it's like, I'm moving commas around, my thought was if this impacts one person, then it's worth it. And I kind of thought that that might be it. I thought maybe they'll just be one person that will come up and say, "I really connected with this book." So it's really just been surreal to have people come up and say, "I'm reading your book, and it's really touched me." It's just surreal.

Erik Weihenmayer:
Maybe this is a dumb question, but that's my last question really, is have you ever had any pushback though? Like doctors say, as we said in the one of the earlier questions, "We're supposed to be kind of invincible. We're supposed to be superheroes. We're supposed to be people that are immune to being a human being. That almost interferes with our job," as we were talking about earlier. Maybe don't rip the band-aid off, don't reveal our secrets.

Benjamin Rattray:
Yeah. I mean, I haven't heard it personally, but I know that that can be one of the arguments is, hey, let's just focus on the technical, be the best we can, technically maintain that professional distance. You certainly hear that argument. But I sort of would counter that and say you look and see if you just compartmentalize everything, at some point, the fisures are going to break. The dam's going to break open. And you end up with all sorts of stuff, like substance abuse, suicide, failed marriages, burnout, early retirement, you name it. So yeah, I haven't heard it personally, but definitely, if you sort of read online forums and stuff like that, you'll definitely see those arguments.

Jeff Evans:
Well, then that's a failure because we want to try and improve the Oprah iceman ratio. I think it can get skewed and be off in medicine.

Erik Weihenmayer:
I found it beautiful. Because it's bringing, obviously your brain, but your heart to the table as well. Which is-

Jeff Evans:
Yeah. Your book is described as above all it's a meditation on humanism and empathy in life's most difficult circumstances and the redemptive power of love, right? I mean, that tells me that that's a read that I don't care who you are and where you are. You're going to find something that you can hang your hat on that's-

Erik Weihenmayer:
Yeah. And it breaks a lot of preconceptions of what we were talking about. So I think that's so good what you're doing, and it's really great to hear your voice and hear your stories. And thank you so much for being a part of No Barriers.

Benjamin Rattray:
It's been awesome talking to you guys. It's such an honor.

Jeff Evans:
I got one more question. So if you're in the middle of a night-

Erik Weihenmayer:
One more question?

Jeff Evans:
Yeah, yeah, yeah. Well, if you're in the middle of a night shift, it's 3:00 in the morning, and your metabolic temperature starts to drop a little bit. You start to get a little cold. Maybe you're getting a little sleepy. And maybe something really big comes in. Do you go straight for the coffee, or do you drink... See, I like that. I like the life hacks. What do you do to get right in that moment, right there in the middle of the sleep syndrome?

Benjamin Rattray:
Yeah. So usually if it's something that's kind of an emergent thing, there's enough adrenaline that just kicks right in. Actually the more difficult thing is doing the paperwork. So we'll have the thing happen say at 3:00 in the morning. You get all this adrenaline kicks in. You get everything done. And then I'll go sit back in the office in front of the computer, and I've got an hour, hour and a half worth of paperwork to do. And at that point, that's really rough. So that's coffee time.

Erik Weihenmayer:
Do you fall asleep and you drool on your computer screen?

Benjamin Rattray:
Yeah, exactly. Yeah. So no, I'll go get a cup of coffee, put on some music, and just start tapping away at the computer.

Jeff Evans:
Dr. Rattray, When All Becomes New: A Doctor's Stories of Life, Love, and Loss. Super stoked to read that. I have a feeling that, I am going to a beach in Mexico over Christmas, so I'm going to send a picture of me reading it with sand in the background, just to be able to reemphasize that. Thank you for spending some of your time. And by the way, we know how amazing of a commodity time is for you. So thank you so much for sharing your story with the No Barriers community, and being a part of our family.

Erik Weihenmayer:
Yeah. We're honored by you. Thanks, man.

Benjamin Rattray:
Thanks so much, you guys. Really appreciate it.

Erik Weihenmayer:
Cool.

Didrik Johnck:
The production team behind this podcast includes producer Didrik Johnck, that's me, sound design, editing, and mixing by Tyler Cottman, marketing and graphic support from Stone Ward, and web support by Jamlo. Special thanks to the Dan Ryan Band for our intro song Guidance. And thanks to all of you for listening. We know that you've got a lot of choices about how you can spend your time, and we appreciate you spending it with us. If you enjoy this podcast, we encourage you to subscribe to it, share it, and give us a review. Show notes can be found at nobarrierspodcast.com. That's nobarrierspodcast.com. There's also a link to shoot me an email with any suggestions for this show or any ideas you've got at all. Thanks so much and have a great day. (singing)



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