Neonatologist Dr. Wister told us what that word means by talking about his work and gave some extremely useful tips on getting through Medical School and practising Medicine as a career.
Born in Seattle, in Washington State, he first went to a small Christian College there, then on to Southern California. His wife also comes from Seattle, and both their families still live there. Entry to Medical School in the US is entirely Graduate Entry, and his first degree was in History, then on to Medical School for four years. This was followed by three years of paediatric training, then three years of neonatology training. Graduating from that in 2012, Dr. Wister became a Consultant. His first post in this role was as medical director for a 60 bed, level 4 unit “where we had pretty much everything from cardiac surgery, bypass, cardiopulmonary bypass. And then, in 2017, our family had an opportunity to go work on a little island in the middle of the Pacific called Saipan, which is near Guam.”
[Saipan is the largest island and capital of the Northern Mariana Islands, a commonwealth of the United States in the Western Pacific ocean.] ‘Largest’ and ‘capital’ may be a bit misleading, as the total population is less than 45,000.]
The family lived on Saipan for two and a half years working for the government hospital “in a very under-resourced paediatric and neonatal service where we had very, very little. So that was a definite change from being in a big unit to a very small unit with very few resources.” But there were other, more welcome, contrasts. It was very quiet, and the family - along with Dr. Wister - were able to spend a lot of time on the beach. This was great for a time, especially with a young family, but Jason began to be concerned about losing his skills as an intensive care unit doctor, and together they decided he should look for another job.
“There wasn't really anything I was particularly interested in the States. So somehow I looked in New Zealand, and there was a position available where I had the opportunity to both do neonatology, which is my primary job, but also teach in the medical school.” That position was here at Otago. “So I teach students like Sophie in her second year, but I also teach in the third year for some of the third year students. And then most of my teaching is in the fifth and sixth year paediatric departments. So it seemed like a really good fit.”
Two weeks after they arrived, the children started school, and two weeks after that Covid hit. Despite this setback, they have been here now for four and a half years, and the family is well settled and enjoying being in New Zealand.
Question Time
Q. What was it that drew you into Medicine?
A. “I was actually going to be a teacher - my wife and I were both in Elementary Education - all I had left to do was 6 months student teaching . . . And my wife and I were on a bus in Spain, and people were talking about going to do medicine. And I turned to my wife and said, what do you think about if I did medicine? She's like, 'Yeah, all right!'" It was just something that seemed right, but he had not had any previous realisation that it was a ‘best fit’ career for him. “And that was as profound as it was!”
“I went back to school and studied hard, applied, and got in. And I've had no regrets ever since. My wife sometimes wonders how it would have been different!”
Kids are awesome, adults gross!
“I went into paediatrics because kids are awesome, and adults are gross! I already had a definite love of working with kids. In my role, I work primarily with the babies. I love babies. I get to hold the babies, which is awesome.”
While he found the medical part of paediatric intensive care very interesting, the downsides were seeing children who have been in car accidents, or have been abused, or have drowned and so on. “I knew that long term that was going to be really difficult for me to deal with emotionally. And so I'm definitely a hospital-based ICU person. ICU’s in neonatal medicine are known as NICU, where “the vast majority of our babies go on to do really, really well. We get to see them coming back at two, three years. They're walking and they're talking and they're running around, and it's really awesome.”
Challenges of Medical School
Q. What sort of challenges did you meet in Medical School, and how did you overcome them?
A. “One of the challenges was I had kids in my first and second years!” Added to that was the much more concentrated material than he had met before. “In all honesty, I breezed through college [for the History degree]. Didn't have to study that hard. [I’m] not super smart, but smart enough. And so it was pretty easy to get through. I studied some, but not really overly hard.” Thinking he would be able to use the same approach in medicine, Jason failed all of his first year exams. “And that was a big wake-up call for me, that this is not going to be how I'm going to survive this.”
He created a study schedule. As soon as classes finished he was off to the library, where he would study for the rest of the afternoon. “ And longer. My wife got used to me coming home late after studying.”
The big difference was being presented with ‘so much information, so fast’. “And that's probably the biggest thing about medical school. The material isn't particularly hard. It's not astrophysics or anything like that, but [the problem is] the volume of material that's thrown at you and how quickly it's coming at you and never stops. And you have to stay up on that, because if you get behind, you're going to be out of luck.”
After qualifying, the most challenging thing is night duty. One might be on call through the week and sometimes and week-ends, resulting in periods when one works through the night, snatches perhaps an hour or two of sleep, then is on duty the next day. “I will say that here life is much better. I mean, my schedule is good. I can get enough money. I've worked at other places where it was basically every third night I was on in the hospital 24-7. So I don't want to make it sound like my life here is really difficult, because comparatively, it's much better.”
Work in His Current Position
Q. What are the highlights of your current position?
A. “I love what I do. And so it's easy to go to work when you enjoy what you do. I love being in the hospital. I love teaching, so it's a perfect fit for me. I think the thing that I enjoy the most of my job is going to deliveries.”
It might be a normal delivery, or a Caesarean section, then a baby is born. “You get the baby dry and you stimulate, and you're getting the baby to breathe. You're waiting for that baby to start crying and screaming. You hear that, and you just feel the relief in the room, because a crying baby is a happy baby, and if the baby's happy, we're all happy. I still enjoy it. It's fun to go to the deliveries. It’s fun to see those brand new babies just being born as they transition from in utero to starting to breathe on their own in the air.”
Dr. Wister also told us he enjoyed performing the wide variety of procedures required: when a ventilator is needed to enable breathing, a tube has to be passed down the trachea, past the vocal chords and into the lungs; needles may be inserted into the chest to drain out air or fluid, “We put IVs, catheters, into the umbilical cord, or central catheters through IVs into the hand or foot, Yeah, procedures are fun! And I also really like working with the students, both second years, and those a bit further along.”
Q. Your schedule is definitely busy. How do you find that balance between working in the hospital, teaching, and everything else a person wants to do?
A. “In all honesty, our [family] life revolves around my job.” Dr. Wister went on to explain how that worked. He maps out his work schedule with his wife, noting times when on call, weekends on duty or covering for someone else, etc. Then they fit in family activities around that.
“If I’m scheduled for work, I have to work, and there’s no way round that . . . My wife understands that, the kids know that, and we just plan ahead. It’s a challenge . . . but you can make it work.” And that means celebrating birthdays on different days, even having Christmas a week later than most other people.
Be Aware of What Being a Doctor Really Means
Q. For aspiring doctors in the room, what would be you best advice for getting through Health Sci., and then the future?
A. Dr. Wister stressed again the need to keep up with the material - studying and staying on top of it. “I know that the entrance here is a bit tough because it's based upon scores. But don't be disheartened if you don't get in this year because there are lots of other avenues to get in to do medicine.”
But he was also at pains to point out that, once you qualify, the job is very demanding: “In terms of doing medicine you need to want to do it and not just because of what your family wants or because you want a good paycheck because it doesn't pay that well. The hours are awful. The time it takes to get there is awful. It's a really, really long road. And if you're not committed to it, then it's not worth it because at the end of the day you have to be willing to go through all of that . . ."
"It's not going to change [as you progress]. I think one of the things that people think is that all you have got to do is get through medical school and the training, and then everything smooths down. [You think] ‘I’m a consultant. I'm the boss now. I can make my own hours. I can make good money.’ It’s really not the case. Your hours are still going to be awful regardless of that. You're still going to have a huge amount of responsibility. The money is not that great. So I don't want to say don't do it, but you really need to be committed to it because it's going to be a really long and it's a tough job. If you love it, it's worth it.”
Work in the Neonatology Unit
At this point, Dr. Wistar told us more about his own job in Neonatology, which is primarily concerned with babies born prematurely, sometimes as early as 23 weeks into pregnancy. “And to give you an idea of what that looks like, a baby born at 23 weeks weighs about the same as a block of butter - around 500 grams. They are incredibly tiny, fragile babies. We go all the way from those very, very tiny babies the way up to full-term babies who have heart problems or GI problems or just infections or breathing issues and everything in between.”
Because of the long term nature of treatment for such infants, they remain in the unit for a long time, until they become ‘feeders and growers’, an expression indicating that they are stabilised and sufficiently healthy to proceed as, more or less, normal infants, so they can go home. During the time they are in the unit, “We get to know the families, which is a really rewarding kind of thing.”
Every day he is on duty, Dr. Wistar goes round to each baby with the team of Registrars, students and nurses. They discuss each case and what the next steps should be. Any necessary adjustments are made, the families are updated, then on to the new babies coming into the unit.
Coping with Death of a Patient
Q. You indicated that treatment of the babies is not always successful. How do you cope with the death of a baby?
A. “That's a good question. It’s not common, which is good. It is probably one of the hardest things that I do in my job, because death of a baby is never easy. Most of the time, the babies who do die are the ones who are very, very tiny, very, very fragile. And you have to be strong for the family. That's something that's sometimes harder, because you feel that grief, too. You've tried everything, and the baby still didn't survive. But you don't necessarily have that opportunity to grieve.” Dr. Wistar went on to talk about the absolute need to be empathic and compassionate towards the family, and be strong for them. “And I cope with it. I will have to sometimes step out, go into a side room by myself, shed a few tears. I go home, and I hug my family . . . I think it is my family tht helps me get through those things.”
He told us also of the disconnect between such an event and then carrying on with his job as normal - no opportunity to take a day off and grieve.
Why New Zealand?
Q. What made you choose New Zealand?
A. At the time they were living in Saipan, and he had mentioned earlier his concern that he might be losing his skills, so they started looking for a position elsewhere. With nothing available on the west coast of the States, “I had no desire to go to Texas or Florida or anywhere on the East Coast,”, he saw the job at Otago advertised in KiwiHealthJobs. He applied, was interviewed in Saipan, but was unsuccessful because he lacked a research background.
But the ad kept reappearing for months, and in the end, Jason e-mailed and asked if there was any point in him reapplying. No problem, so he did. Next thing was an invitation for an interview, and he and his wife flew from Saipan to New Zealand for that purpose. He was offered the job that same day of the interview.
There was still the family, of course. The two girls were all for it, and their 7 year old son said, “Sure, let’s do it!” Family in the States were not so happy, but his immediate family have not regretted their decision, both girls now being in their first year of University.
“Sometimes things come along in life, you're not really expecting, you just kind of go with it. I chose History because I was already very close to having my History degree. As part of my education degree, I had taken a tonne of History classes and I just liked History. And so it was easier to do History.”
But to meet the prerequisites for Medical School, he still had needed, along with doing History, organic chemistry, physics, biology and genetics. The History has helped his writing, however, being able to write for research and putting presentations together.
Medicine here versus in the US.
Q. How different is it to practise Medicine in the States compared to New Zealand?
A. Dr. Wister first noted that there is a lot more money in the States, “so we get a lot more shiny gadgets . . . and the resources that are available in the States are much greater.” The big downside is the lack of a Welfare State, only medical insurance, which is a personal choice anyway. “For the families themselves, if you can imagine, even if you have to pay 10% on a $2 million bill, that's a huge amount that the families are responsible for.” In contrast, in New Zealand, “families are able to go out of the NICU with no bill whatsoever . . . We have to think about that as we're deciding what to do. We have very few specialists, such as for paediatric neurology and surgery, so a lot of our surgical babies end up having go to Christchurch or Auckland.
In the States, you worry a lot about being sued. You're told as a medical student, ‘it's not if you're going to get sued, it's when.’ I never got sued, luckily. But that's definitely something that you think about.” Associated with the prospect of being sued is the need to keep meticulous (and voluminous) notes in fine detail each day, just in case.
In New Zealand [astonishingly] there is no computer system available to him. Charts and medications have to be written out longhand, and the lack of nationwide medical records means it is not easy to see the progress of those cases that have to be transferred elsewhere. (Later Dr. Wister told us that every DHB is on a different system, although ‘it is said that’ a unified system is in the pipeline.)
“Another difference is here, because we have fewer people, I go out and I do transports. So I get to ride in the helicopters fairly frequently, which is fun. I like riding in the helicopter. It's pretty cool being able to see the coast going on the helicopter. We cover all the way down to Invercargill, Queenstown, up to Timaru, but we also have gone out to Greymouth and everything in between.”
What he described as “my most interesting transport” involved landing in a paddock in Miller’s flat to care for premature twins born at home. Babies in need of artificial temperature and humidity maintenance are placed in devices known as ‘isolettes’, and they had to carry those across the paddock, through a fence that had been partially taken down for the purpose, over the highway, across another paddock, up the driveway and into the living room. “Babies were doing really well, luckily. I was worried I was going to have to do some emergency stuff on the kitchen counter.” With babies in the isolettes, they made their way all the way back to the helicopter. In the States, such a trip would be done by a transport team.
Isolettes are also used in the Unit, ”Sophie will get to have a chance this year to come into the unit.” Everything is done with the babies in the isolettes, which have ‘doors’ in them. “At some point, they'll graduate into a cot when they're able to maintain their own temperatures without being in the isolette . . .We have one on wheels, for transport.”
Research, Travel, Covid and Giving Up
Q. Do you have any personal research on site?
A. “Yes, most of my research is Unit-based.” Because formula milk is associated with bad outcomes in the babies in the Unit, he is researching lengthening the storage life of donor Mother’s milk by freeze-drying with the Food Science department. Frozen donor milk only lasts for three months. “We don't have a donor milk bank here in Dunedin. There's no national milk bank.”
Dr.Wister spends quite a lot of his time on curriculum development as well as teaching.
Q. Are there any experiences you have had, such as travel, through working in Medicine?
A. Noting his time in Saipan as one, during which he and his family visited Korea, Japan and Hong Kong, he commented that it was having his particular skills in Medicine that enabled him to come to New Zealand. Travel has, however, kept them away from the rest of the family, and they plan to visit the States in June. “The medicine that we provide is excellent, but the infrastructure is oftentimes lacking around those things that we don't think about quite as much, but are hugely important also. “
Q. Has your work been impacted by COVID?
A. “If anybody had the slightest bit of a sniffle, they were not allowed into the Unit . . . We had no babies getting COVID. We actually had very few paediatric cases getting COVID . . . We had all these plans and policies and everything in place. And then nothing ever really happened for us. The main hospital did have some problems with COVID, but this Unit did not."
Q. Has there ever been a time when you felt like giving up?
A. “ Not really. I think in training. Our training was much more intensive than it is here."
"In my first year of training after medical school, I was on call. So I would show up at 8am in the morning. I would be in the hospital until 12pm the next day. We would do rounds on our patients. We would be there all day. We would be there all night doing overnight admissions and coverage."
"And then we would do rounds on our patients the following day until 12, and then we could sign up and go home. And we would do that every fourth day. So 36 hours overnight, every fourth day. I did that seven out of the 12 months of my first year. Luckily, I was a little bit younger. I can't imagine doing that now. There were nights when I was just like, 'I can't do this anymore.' But you go home, you get a night's sleep, and you're okay. I wouldn't say that there was ever really a time when I seriously felt ‘I just can't do this anymore.’”
The biggest problem was not seeing his family. Certainly he was earning a lot of money, but his children and his wife were not happy that they saw so little of him, which was also a factor in him taking the post at Saipan.
Q. Where did you enjoy working the most, Saipan or New Zealand?
A. Dr. Wister and his family loved Saipan, with its laid-back beach life. “I would take calls sitting on the beach, or go out on the paddle board, and they waved me in when my phone rang. It was really chill. In terms of the job itself, there wasn't a whole lot going on. I really like it here, because it gives me the opportunity to still maintain my skills, still work in a high level unit, but also gives me the opportunity to do a lot of teaching, which I really enjoy. And the light and the schedule is actually quite good, relatively speaking. We have paediatric registrars who cover the unit at night, so I can be at home. And so it's actually pretty good. So I would say here."
Med. School in the US
Q. You mentioned earlier that training in the States was much more intense, so would you say Med. School is a lot harder there?
A.” I don’t know that that it is necessarily harder, it’s just that the structure is different. We already have our college degree. The first two years of medical school is similar to what you guys, I think, have for your Health Science first year.” So in that first two years there was no clinical training, whereas in New Zealand students already have some in second year. In the States the final two years is entirely clinical, no classes, no exams, but there are such things as taking overnight calls as students. Those students are a bit older than here, and hold a degree. “So I think they kind of push you into that a little bit. And the workout rules here are much stricter than they are in the States.”
There is also a different approach to work-life balance with a tougher approach in the US, people often working 36 straight hours, with the attitude of those above them, ‘I did it, so you can do it, too.’ “We try yo treat our Registrars a little bit nicer than that.”
Sleep Deprivation, Consulting Colleagues, and What is Really Wrong with this Patient
Q. When you don’t go to sleep for that long, do you start to make mistakes?
A. “Definitely. You know that even if you’ve been up all night, the next morning, it's hard to concentrate . . . It’s kind of a badge of honour [in the US] . . . drink some more coffee, and just deal with it.” Dr.Wister further commented that, after a long sleepless period, even simple mental operations could be difficult, “Writing medications, wow, this is really complicated . . . But you can ask for help.” He expanded on this, saying he would always consult a colleague, or get a group of workers together to discuss a tricky case. “Someone always has a different perspective, and you say, ‘You know, I hadn’t thought of that.’ And sometimes you just have to know your limits. You have to say, ‘You know what, I am exhausted, I cannot think. Can you please cover the unit for me for four hours so I can go home and get some sleep?’ And we will do that.”
Q. What would you do if you can't figure out the solution?
“I think probably the thing that people don't realise about medicine is how much we don't know, and we may never know. There are many, many times when I just don't know what's going on with a patient. I don't know what's causing their symptoms."
"I've ruled out all the things that I need to rule out. I'm going to say, I honestly don't know what they have. But I know it's not x, y, or z. And those are the things that we need to make sure that we've ruled out. And you hope they get better. Time fixes a lot. Sometimes all you can do is say, ‘we've ruled out all the bad stuff.’ And we're just going to wait and see what happens. We do that a lot in medicine, way more than people think.”
The Demands of Working in an ICU
Q. Would you say your speciality is more demanding than others?
A. “Yes . . . If you're in ICU, any ICU, your hours are going to be much more difficult, because you're going to be called in in the middle of the night, you're going to be working overnight. This is something that you have to say, ‘I'm either willing to do that and learn how to live with that, or I'm not.' And, you know, if you are, if you like working in the ICU, then it's worth it. If you don't, then it's definitely not!”
Q. Do you feel staying up and working a lot has kind of affected your own health?
A. “I don't want to make it sound like my job is really awful, because most nights, you know, when I'm on call, I stay at home, and I sleep in my own bed, and I get up at a decent time. Other places where I've been working multiple nights in the hospital overnight, I think I probably got pretty grumpy. I think my family probably would say, ‘You were definitely affected.’ I didn’t get sick particularly a lot, but doctors have that, ‘I'm never sick, even when I'm puking in the toilet while I'm on call.’ I had a friend who's also a neonatologist who literally was walking around with an IV pole and an IV while she was on rounds. So there's definitely that idea of 'we can do everything.’ But I would say for the most part, not a huge amount, but it definitely, I think, can affect you. And you should probably stay home if you're sick!”
As a final comment Dr.Wister noted, “I always bring my clinical skills tutorial group into the Unit and I show them around and let them see the babies and play with their stuff. So she'll [Sophie] get that opportunity. (Sophie: “Very excited!”)
