Dr. Monica Arroyo serves as a pediatric neurologist on Hope for HIE’s Medical Advisory Board.She completed a pediatric neurology residency and subsequent fellowship in fetal and neonatal neurology at Cincinnati Children’s Hospital Medical Center in 2018. During her fellowship, Monica delved into how complicated it is to not only treat the patient, but to support families in the midst of the grief related to having a future that was different from the one they envisioned. Currently, she works at Joe DiMaggio Children’s Hospital in Hollywood, Florida, where she started a dedicated neonatal neurology service, fetal consultation service, and a high-risk NICU follow-up clinic.
Not only has it been rewarding for Monica to round every morning in the NICU and spend as much time with families as she wants, but it’s been rewarding to continue to serve families post-discharge via the clinic. As an advocate for optimizing continuity of care and for creating safe medical homes for children with complex needs, Monica is proud of the holistic approach she has helped to build at the high-risk NICU follow-up clinic. Through the collaboration of multidisciplinary team members, such as neurologists, physiatrists, therapists, and social workers, families at the clinic can receive the medical, emotional, and logistical support they need to thrive in their journeys.
Monica understands firsthand how traumatic the NICU experience can be for parents, as she herself is a NICU mother, whose child passed away from complications due to prematurity. She always looks for ways to not only serve as an informer of medical news, but to support parental mental health. To help HIE parents feel less in the dark and more engaged in the care of their children, Monica gives them frequent updates about what is going on in a concrete, simple manner. Because it’s overwhelming to be flooded with so much information all at once, an approach that Monica finds particularly helpful is giving parents a plan for the day. This way, parents can take it one step at a time, remaining grounded in the present instead of worrying too far ahead into the future.
Before MRI day—frequently the climax in the NICU stories of HIE families—Monica forms relationships with families and learns about their backgrounds. That way, when it comes time to have those often-difficult conversations about the MRI results, she can frame information in the context of each family’s unique values and wishes. Since MRI day is daunting for families, Monica tries to clear her schedule to spend as much time as necessary comforting families and answering all their questions. In the meetings, she practices humility, admits to uncertainty if it exists, and leaves the door open for further conversation. Before ending the meetings, Monica reassures families that, while there is no crystal ball about what the future will look like, one thing is certain—she will continue to walk alongside parents every step of the way, not only within the NICU, but also in the outpatient setting. Even though the journey is terrifying, Monica finds that offering this hand of support helps families feel a little less alone.
Monica is proud that she has been able to create purpose from one of the most painful experiences of her personal life. In her daily interactions with families, she often reflects upon the loss of her son in the NICU five years ago. While she didn’t lose her son due to HIE, she still had that lived experience of everything going devastatingly awry. She experienced feeling like she’d failed as a mother, unable to keep her baby safe, even though she was entering a career path to help critically ill children. So, if parents, at times, displace their frustration on her, Monica doesn’t take it personally. Instead, she leans into her experience of knowing how terrible it feels to have a less than desirable outcome, understanding that the ebbs and flows of grief are a natural part of the process.
To further support parents, Monica has the social worker meet with every parent who comes to the follow-up clinic, even if a parent appears “fine” on the outside. She has seen firsthand that you cannot predict which parent is struggling the most, or is suffering with PTSD, simply by asking how the child is doing. Some of the parents who have cried the most have had children who are doing relatively well, in terms of neurodevelopmental outcomes. Thus, Monica always invites parents to open up about their emotions by simply asking them how they are doing. If a parent is feeling burned out, she explicitly gives them permission to take breaks from therapy. She normalizes the concept of going on a vacation for a few days, reminding parents that playing in the sand is a form of occupational therapy. If parents discuss intense emotional needs that are beyond her area of expertise, Monica validates their feelings and helps them find the right mental health provider. Sometimes supporting a parent’s mental well-being means acknowledging the boundaries of her capabilities as a medical professional.
Not only do parents struggle and face burnout, but so do providers. It’s not easy to constantly hand out difficult news, so Monica finds various ways to recharge herself throughout the day. For one, she leans on the wonderful team of providers she works with for support. Even though they all see patients from different angles—whether it’s from a neurology, nutrition, physiatry, therapy, or social work standpoint—Monica finds comfort in knowing that everyone on the team contributes equally and is dealing with similar feelings. At the lunch meetings in the high-risk clinic, where the entire team sits together to review cases, Monica remembers that it’s not just her operating in silos, but that everything truly is a team effort.
Self-care for Monica also means recognizing that it’s okay to ask for breaks herself, so she can spend time with her family. It also energizes Monica to immerse herself in communities of other healthcare professionals, such as Hope for HIE’s Medical Advisory Board, learning about what people at other institutions are doing, and participating in quality improvement projects. It excites Monica to engage in research examining whether there are prenatal clues that predict which babies are at risk for developing HIE and in efforts to spread awareness about neurologic conditions that are diagnosed in the newborn period.
Most of all, what fuels Monica’s passion for the work she does is the amazing patients and families she interacts with. Through her patients, she has the privilege of being a firsthand witness to hope, seeing children thrive in incredible ways despite initial predictions based on MRIs. Monica doesn’t view these cases as miracles with no fathomable explanation. Instead, it’s due to the resilience and perseverance of both parents and children alike that these outcomes surpassing all expectations come to fruition. Parents who view their children’s lives as ones of limitless potential have effervescent fires burning inside of them—they are the true miracle workers. Whether it is by showing up to the NICU every day, educating themselves, following medical advice, thinking outside of the box within reason, or allowing their children to write their own stories, parents have the power to foster their children’s development.
For Monica, what’s more rewarding than any big publication, promotion, or accolade is receiving pictures of her patients or invitations to their important life events. Not only does it fill her with irrevocable pride to know that these families think of her as essential to their children’s lives, but it’s amazing to see that life can still be so happy, even if it’s not the classic definition of “perfect.” Monica has always told herself that the marks of a great doctor are empathy, humility, and a door full of Christmas cards on both sides.
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