Neonatologist Dr. Susan Landers Talks About Physician Burnout Working in the NICU

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As a neonatologist for over thirty-five years and a mother to three of her own children, Susan Landers, MD describes how the full-time practice of neonatology influenced her experience as a mother. As a neonatologist, she survived and thrived during a lengthy NICU practice, and she relates her experiences of finding resilience and endurance, managing to postpone burnout until late in her career. The book describes many technological changes that she witnessed over decades in neonatal medicine and high-risk obstetrics, such as infertility treatments and multiple births.

In her memoir, So Many Babies, Neonatologist Dr. Landers shares the stories of the close relationships that NICU staff and parents develop during some of the most distressing times of their sick child(ren)’s lives. In addition, Dr. Landers’ memoir describes how the practice of neonatology shaped and influenced her life experience. So Many Babies is a fascinating book about Dr. Landers’ experience working in the Neonatal Intensive Care Unit (NICU) and the many poignant life-and-death scenarios for critically ill patients and their parents.

Dr. Susan Landers (Courtesy photo)

Susan Landers, MD chats with the Los Angeles Post Examiner about her book, “So Many Babies: My Life Balancing A Busy Medical Career & Motherhood.”
What is your book about and who is the audience?

“So Many Babies” is about my 30-year-practice as a neonatologist taking care of sick babies in the NICU. My book relates stories about some incredibly special patients – some premature, some multiples, some born with severe birth defects, and their parents – each of whom them touched me in profound ways.

My book relates stories of my learning how to be a good enough mother raising three children of my own while practicing full time. My hope is that my motherhood journey will be reassuring to other working mothers.

What was it like to work in the NICU?

Working in the NICU often felt like working in a whirlwind. It was always exciting, and usually extremely rewarding. Watching babies respond positively to new technologies and treatments was gratifying; however, watching babies die despite full support was heartbreaking, and sometimes felt defeating.

Sometimes the NICU was incredibly stressful, especially in life and death situations, or challenging ethical cases. Sometimes it was tragic and the NICU was a difficult place to work, especially while experiencing the suffering of some of the sickest babies and their parents. Sometimes the NICU environment was noisy and almost nerve-wracking, and other times it was quiet, calm, and subdued. There were always surprises and I enjoyed being part of a NICU team that was ready for anything, even quadruplets on a Sunday evening.

In 2020 the medical industry experienced medical burnout from the sheer number of COVID cases that came through the emergency rooms at hospitals. Besides this factor, why do you suppose that medical doctors experience burnout? Why did you experience it and what did you do about it?

The stress of multiple patients presenting at once and overwhelming the system (feels like a natural disaster), watching older patients suffering alone, the lack of available ICU beds, nurses, and therapists in some facilities, the lack of available resources early on (adequate PPE, enough ventilators, not knowing the best drugs to use for the complications they were seeing), and the stark severity of the disease in most hospitalized patients all contributed to their burnout. These culminated in moral distress, the real culprit causing physician burnout. These healthcare providers were physically and emotionally exhausted, another major factor in burnout. When they felt that they could no longer make a difference, then they experienced the ultimate psychological injury.

I burned out at sixty-two years of age. I was physically exhausted from too much night call, something that your body does not tolerate well as you age (past fifty). The emotional exhaustion I felt was a result of too many extremely premature babies surviving with significant neurological injuries because of their prematurity. Sometimes their parents were reluctant to accept reality and allow some of these babies to die naturally, and I found that situation stressful. At other times, when a baby would not respond to our treatments, I felt a baby’s death as a failure. Watching an infant die, being with his parents during this process, is tragic and heartbreaking, and one can only take so much of that.

My burnout resolved after two years of part-time practice, mainly attending to normal newborns, taking far less night call, handling far fewer emergency deliveries, and having to resuscitate (successfully) only two babies in two years. In addition, I played the piano, joined a handbell choir, enjoyed exercise at least four days a week, took long walks outdoors, had lunch with friends weekly, escaped into many wonderful novels, and talked to a psychotherapist weekly.

In your book, “So Many Babies” you are very candid about being a NICU doctor and a mother at the same time. Tell us about the sacrifices that you’ve taken for your patients and how do you think this affected your home environment?

Throughout my career I clearly worked too many hours and was away from home in the NICU too many nights. My pediatrician husband took good care of our children when I was away, but that oftentimes was two nights per week. During those times, my children probably missed me. I tended to bring my work stress home with me, and despite the advantage of talking with my understanding husband, that must have impacted my children. There may be such a thing as trickle down anxiety at home if mom is stressed out and edgy. I believe that I yelled at my children too much. I was able to be patient and controlled in the NICU, but sometimes lost control at home. Funny, how the chaos of three children can be more overstimulating than a NICU full of sick babies.

Can women in medicine ever really have it all? What would you like to tell young physicians?

Yes, they can have it all, but it depends on the specialty and the total number of hours they choose to work. Dermatologists, ophthalmologists, and radiologists probably have it easy compared to ICU doctors and surgeons. I know physicians who choose to work only three or four days a week, and they seem to enjoy their personal blend of medical practice and family life.

Regardless of the specialty, the physician mother will find herself making tradeoffs and constantly feeling like she is juggling her work and her kids. There is no work-life-balance unless she makes it happen. You cannot be with your children when you are at work, nor can you be two places at once.

What are some of the highlights of being a NICU neonatologist? What are the hardest parts of the job that medical school doesn’t prepare you for?

Being a neonatologist allowed me a special kind of intimacy with the parents of my patients. I felt like a part of the family, alongside of them from the delivery and through many weeks, sometimes months of care for their baby(ies). I cannot overstate the wonderful sentiments this process evoked in me. I was so grateful to really know so many strong, but stressed parents. My career provided me with quite a wonderful life, and I was privileged to see many great advances in neonatal intensive care during my decades of service.

Medical school did not prepare me for the everyday grind of medical practice, the constant interruptions, and the feeling of being pulled in many directions at once. Nor did it prepare me for the angst of participating in those toughest ethical cases. (Some of these I discuss in my book.)

Dr. Landers, is there anything else you’d like to add that I didn’t ask?

I hope that readers of my book will find the stories of my special NICU patients and their parents as inspiring as I did. I also hope that other working mothers will find in my personal stories some reassurance that they are doing a good job raising their children. I want them to know that they can be a good enough mother for their children while also working full-time in a career they find fulfilling.

Her book So Many Babies: My Life Balancing A Busy Medical Career & Motherhood, is available on Amazon.

To learn more about this compelling book, check out