For nearly 40 years, neonatologist Stewart Lawrence, M.D., has focused on taking care of critically ill babies. Midway through his career, he helped start the neonatal intensive care unit (NICU) at Saint Alphonsus Regional Medical Center in Boise, Idaho, and in December will retire from practice. This Prematurity Awareness Month, we’re honoring both Dr. Lawrence and his team.
As NICU medical director at Saint Alphonsus, Dr. Lawrence is a natural in the role. In the 20 years that he’s been in Boise, 4,300 babies have been treated in his current NICU. Ironically, however, during his residency at Duke University School of Medicine, Dr. Stewart’s least favorite place was the NICU. Back then, physicians didn’t often discuss cases with other physicians in other NICUs and worked essentially in a vacuum. There were no clinical trials in the field. Most of the care provided was based on anecdotal, experience-based medicine, not the evidence-based medicine that has become Mednax’s hallmark.
“I was overwhelmed by the futility of the situation. We were constantly providing emergency care, and as an intern, I felt useless,” Dr. Lawrence remembered. “There’s nothing worse than being in a crisis and not knowing how to help. Every day I’d look at the doors of that NICU, and I’d have to steel myself to go in. My first month in the NICU, I couldn’t wait for my shifts to end.”
Then one night during his second year of residency, a fellow placed a chest tube in a baby, finished her shift and signed the child out to Dr. Lawrence. A half-hour later, the baby began to deteriorate. An X-ray revealed that the tube wasn’t placed properly and wasn’t draining. The baby was suffering from bilateral pneumothoraces (a condition that occurs when air leaks into the space between the lungs and chest wall) and a pneumopericardium, a collection of air or gas in the pericardial cavity. Dr. Lawrence stepped in and realized he knew what to do.
“That was the moment I became aware that I could do these types of things,” he said. “The baby needed drainage tubes placed quickly and successfully, and there was no time to call a more senior NICU doctor or surgeon. Otherwise, we would’ve lost that baby.”
Following residency, Dr. Lawrence completed his neonatology training in Texas and subsequently worked in Texas and Florida. Then in 1991, a friend called about a job at a hospital in Boise. Ten years later, he moved to a competing hospital – Saint Alphonsus – to help start its NICU.
At that time, Saint Alphonsus saw about 300 births a year. The first patients admitted to the 6-bed NICU were 24-week gestation twins. Since then, Dr. Lawrence and his team have helped expand the unit to 32 beds with isolation rooms, surgical suites and transition rooms. The hospital sees about 1,700 births now, and the NICU’s census typically hovers around 18. The unit was the first in Idaho to use neonatal therapeutic hypothermia, which moderately reduces a patient’s body temperature to enhance neurologic outcomes in select infants. .
In August, the NICU celebrated 20 years. He says St. Alphonsus’s NICU is like a boutique hotel; they give personalized, attentive care to every patient.
“The mantra I’ve been telling staff since day one is, ‘Every baby and every family is the most important baby and family we’re going to take care of today,’” Dr. Lawrence said. “When you’re feeling overwhelmed, focus on the baby and family in front of you now. Then, we’ll figure out the next baby.”
He still remembers the baby girl born at 27 weeks after her mother’s water ruptured at 22 weeks. The baby had pulmonary hypoplasia—undergrown lungs—due to her mother’s oligohydramnios, a lack of amniotic fluid. A breathing tube was used to help oxygenate the baby. However, after continued treatment, including the experimental use of inhaled nitric oxide to improve blood flow through the lungs, the baby became increasingly hypoxic, and the family came in to say goodbye. Dr. Lawrence stepped away to give the family privacy when a colleague called to him.
“I looked at the saturation monitor and it started to go up. I walked over to the bedside when it hit 75 percent, and it just kept rising,” Dr. Lawrence remembered. “Everyone on my team still remembers exactly what they were doing at that moment. The mom’s eyes were riveted on the baby’s face. It was an incredible moment to see her improve.”
That baby’s photo was the second one added to the unit’s “Wall of Hope.” The first photo displayed was of the 24-week twins.
In December, Dr. Lawrence will retire from medicine, a decision he didn’t make easily.
“Being a neonatologist has made the biggest impact on my life,” he said. “While I’m not running for the exit, I can feel that my odyssey is coming to an end.”
Once retired, Dr. Lawrence says the plan is not to have plans. He and his wife, Grace, hope to continue their yearly cycling adventures with a trip to the Piedmont region of Italy. Beyond that, his schedule is clear.
“People often describe me to others as ‘passionate,’” Dr. Lawrence said. “I’d like people to remember that I was passionately devoted to the care of babies and their families.”
See why Dr. Lawrence chose to work with Mednax. Browse our opportunities: https://www.mednax.com/careers/.