Baby Talk : Communication in Pediatric Healthcare

By- Dr Rupali

Although my exposure to paediatrics is limited to the 30 days of internship in the Paediatric ward and NICU, I learnt more about communication in those 30 days than all of the other 335 days of gruelling internship. To make things a little more interesting for you, I’m going to start by telling a story from that rotation and completely ignore the prompts given to me by the editors (sorry Akanksha and Mahima!!)

My paediatric rotation started off with a bang – and by that I mean the nurses strike. This came on day 1 of my posting in the NICU when I barely knew the ‘P’ of Pediatrics. So just to give you a clearer picture – in a 20 bedded NICU, we had 1 paediatric resident (JR1)  in the NICU 24/7 (who also had to run up to the delivery room every time there was a delivery, which in my hospital is like every 5 minutes, to deliver neonatal resuscitative care), accompanied by 2 very new, very clueless interns, one of whom was posted from 9:00am to 2:00pm and the other from 9:00am to 6:00pm rotationally.

With the nurses strike this meant that the 3 of us now had to do EVERYTHING. By that I mean, take the babies for all their  referrals – 7 different departments if I remember correctly, write the notes, change NG tubes a billion times a day because lil babies love pulling them out, and now the additional work of administering medication every couple of hours. We would just be on our feet in those 8 hours. It was so hectic that the “missis” (student nurses) sent to alleviate some of the pressures even had a breakdown. And I mean that literally, one of them started crying because her feet hurt from standing all day and we felt horrible for her so we just asked her to take some time off. Long rant short, we were working in less than ideal conditions. We would sometimes have a senior resident (JR2) come down from the ward to help out as well because the NICU would’ve definitely fallen apart otherwise.

But, even in these harsh conditions, my residents never stopped communicating. They were still kind to us, the nurses, and the parents which is rare in a resource constricted government hospital setting in India. What I think we found particularly challenging was talking to the parents. These were new parents who had, perhaps, had their first child, and telling them about unfavourable outcomes was heartbreaking. No amount of “Breaking The Bad News” training can ever prepare you for it (Not that we ever received any training like that). It hits like an avalanche – the feeling of devastation and failure is indescribable. This is a little baby you have been looking after for weeks, and one day, you need to tell their parents the worst news of their life.

Once the NICU nurses’ strike ended, I had the opportunity to speak to them about dealing with this since they had been around here the longest. One of my favourite NICU nurses told me that it’s really difficult but she looks at the silver lining. The parents only knew the child for maybe a few weeks or months so they would be hurt, but with the right support, they would learn to move on. She said it’s so much harder when the child is older since there are so many years of memories that stay with you. That was a conversation that really changed my perspective about loss and communication.

Since I worked in a busy government hospital – we had all sorts of children coming to us, some only simple cases that got better with the right intervention, while others required specialised care and support. From my head of unit, I learnt the importance of communication in all kinds of children, especially those who were specially abled. He always addressed the parents and children with kindness but was also firm when he needed to be. Another really interesting approach was how he would ask parents to demonstrate how they used the inhaler and spacers with their children in every asthma OPD. In paediatrics, the communication isn’t just verbal. It’s important to consider a combination of techniques such as demonstrations, imaging and writing.

Throughout my rotation in paediatrics, I saw kindness and care. Qualities that are rare and almost unheard of in most departments in a government set-up. Even the nursing staff, mamas and maushis were chatty and helpful. The nursing staff made sure the children were well taken care of in the wards and the parents clearly understood their role in the management of the children.

I learned more about medicine in these 15 days that I could have ever hoped to learn. I don’t mean the cases, diagnosis and medication part – that bit is easy. But about how being a doctor is so much more than that. We had the lives of tiny hoomans in our hands, with mine being the most inexperienced ones there, but we tried our hardest, despite all of the odds being against us. I hope you, dear reader, have the privilege of experiencing this at some point in your medical career as well because it truly changes you to the core.