One of the best things about starting this blog has been hearing the stories of my readers who’ve taken me up on my offer to start a conversation, reaching out to me to commiserate and exchange words of encouragement. It has been my greatest joy from this whole experience, and it encourages me to keep going every week.
On the day that High Plains MD (formerly known as Frontier Doc) fully told me his story, I sat in shock at my dining room table. I had to read, then re-read his email an additional 3 times to fully digest all the grief, betrayal and anger his story evoked.
I’m not typically easily moved to tears, but I’m not ashamed to say I ugly cried before I sent him my reply.
Today, I’m paying it forward as The Happy Philosopher did for me when I first started writing, asking me to guest post the nitty gritty details about my script and burnout story on his blog. Now it’s High Plains MD’s turn, and I’m so honoured he’s agreed to allow me to share his story with you here, in this space as my first guest post.
I hope it touches you as it did me.
“I have severe polyhydramnios and I am being induced… we are having a baby today!”
Almost one year to the day after starting my first “real” job as a doctor, I received this phone call from my wife in the middle of a clinic day. Her due date was still 3 weeks away. I was guardedly excited.
We hadn’t really planned for this. Nonetheless, I had prevailed upon my partners to make backup coverage plans in case something did not go according to plan. Coverage plans did not materialize.
A short while later, my wife updated me she wasn’t close and I didn’t need to hurry, but should start making my way to the hospital. After finishing up a patient visit, I informed my CEO and clinic manager I needed to go because my wife was in labor. They told me they would handle everything.
A quick literature search revealed that severe polyhydramnios was associated with a 50% chance of significant fetal abnormalities. My heart sank. Everything had been normal up til now. I relayed the details to my supervising partner, letting her know we might be in the NICU for a while.
A BABY CHANGES EVERYTHING
Our daughter was born seven hours later. She required significant resuscitation, intubation and transfer to the NICU. She didn’t seem to be able to breath or swallow on her own.
Over the first few days of her hospital stay, I spent a significant amount of time relaying information to my partners. I did this because shortly after starting that job, I had learned our call system was anything but systematic. The call schedule resembled a patchwork of bandaid solutions and stop-gap measures. No parameters, no predictability.
Presumed chaos was the rule.
Even despite letting my partners know about the due date, I had been scheduled to cover a weekend 10 days before her due date. Now she was already here and on a ventilator.
“WE’LL HANDLE EVERYTHING”
This turned out to be a lie – I received multiple texts a day from clinic staff regarding patient’s results, questions, etc. I felt the need to cover my inbox, because we lacked any system for inbox coverage.
Even after a sit down meeting to explain to the administration that this was not okay, they seemed nonplussed.
Time did not lead to any improvement in my daughter’s condition. We started having end of life discussions.
During that week, my supervising partner asked me to cover 12 hours of emergency department call. Apparently, no one else was available. I wondered in silent shock what was more significant than being at the NICU bedside of your newborn daughter with your spouse…
THREE WEEKS AND A LIFETIME
We took her home on hospice. She was extubated on our front deck by our neonatologist who drove 45 miles through the mountains to be there with us.
Despite our decidedly nondenominational quasi-agnosticism, he read Jewish prayers for her and us upon her passing.
It was the hardest, yet also possibly the most beautiful, day of my life.
“America’s health care system is neither healthy, caring, nor a system.”
― Walter Cronkite
SAME SHIT, DIFFERENT DAY
I returned to work less than two weeks after she passed, too soon it turned out. I had assumed I would ease back into work, since it had to happen sooner or later.
My partners’ assumption was that I would return to work at 100% of my previous call responsibility. This included 120 hours of call Thanksgiving week, including Thanksgiving Day as well as the 72 hours prior to 8 AM on Christmas morning and the 24 hours starting at 8 AM on the day after Christmas.
Staring at the holiday call schedule, the message seemed clear to me:
“Other people have living children, so it is more important that they be with their families.”
I was fighting to maintain any semblance of boundaries. My world had been turned upside down, but the healthcare machine had to keep on churning out RVUs.
“THE OTHER DOCS ARE RUN PRETTY RAGGED, TOO” AND OTHER GREATEST HITS HEARD AFTER RETURNING TO WORK
After effectively being told that it would be too difficult to find someone else to take my call:
Me: You know, I still have over 30 days of paternity leave I could take. I don’t have to be here, I came back to help.
Partner: Well, it would have been easier to arrange coverage if we’d been able to plan for it.
——
CEO in one conversation: We want to support you however we can, but the other docs are already run pretty ragged right now.
CEO in another conversation: We may not always do the right thing, but our hearts are in the right place.
——
In a conversation about me possibly switching to do just hospitalist/ED work:
Same Partner as Above: I would hope that you think about the burden it would put on us to cover the outpatient work if you were to do that.
*MIC DROP* – THIS LONE RANGER IS SUNSET BOUND
And so I left, self-preservation seemingly the best I could manage. I now wander the High Plains, an itinerant critical access hospital doctor. Even before my partners and the healthcare machine tried to chew me up and spit me out, I knew something was wrong.
Over at the The Happy MD, he refers to the Lone Ranger identity. This is the ethic that states the individual physician bears responsibility and we have to do it all alone. It is not healthy.
LOOKING FOR MY TRIBE, FINDING A GAGGLE OF LONE RANGERS
As a millennial physician, I grew up in the world of team-based care, evidenced based medicine, and “To Err is Human.” I graduated a rigorous, work-hour rule bending residency program that still managed to provide a supportive environment filled with camaraderie.
We celebrated success and newfound skills together. We also suffered, grieved loss and failures – together. The togetherness gave it meaning.
I was eager to join the community of practicing physicians. On the other side of board certification, I found no such community. Rather, I found merely a group physicians in close proximity doing similar tasks, but in pursuit of individual and often disparate goals.
In my search for community, I found myself alone.
“We will, in truth, spend many of our hours alone with our grief….[Yet,] our ability to drop into this interior world and do the difficult work of metabolizing sorrow is dependent on the community that surrounds us. Even when we are alone, it is necessary to feel the tethers of concern and kindness holding us as we step off into the unknown and encounter the wild edge of sorrow.”
― Francis Weller, The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief
PHYSICIANS LIVE WITH GRIEF EVERYDAY
As physicians, we grieve with patients daily. We grieve for their loss of loved ones, of health, of abilities, of memories. We do this daily. It cannot be born alone.
Facing down the greatest grief I have ever known, I shockingly found my supposed tribe was anything but. I was call coverage to partners, an RVU generator to my health system. When I struggled to meet those requirements, I was expendable.
Injured Lone Rangers do not have long careers.
THE DOCTOR’S LOUNGE SERVED A PURPOSE
From what many older doctors tell me, physicians had camaraderie and collegiality in the “good old days.” The doctor’s lounge was a place to commiserate over bad outcomes, pick your colleagues brain’s over a tough case, complain about the parts of the job that sucked and feel heard.
The good old days were also rooted in sexism, elitism, patriarchy, and preservation of personal and professional privilege – often at others’ expense. I am not suggesting we bring it all back. Yet, we have not replaced doctor’s lounge with anything else.
PRODUCTION AS A MEANS OF CONTROL
Increased isolation is a byproduct of the incessant push for increased productivity. Surgeons run from OR to OR, hospitalists from bedside to bedside, family doctors from exam room to exam room.
People – nurses, staff, and patients – surround us all day. However, in our professed calling – doctoring – we are alone nearly every minute of the day. When the doctoring is done, we then spend even more hours alone, sitting in the pale, lonely glow of a computer screen, documenting.
Does the system know this? Somewhere, it seems to know if we are too busy to converse with our colleagues as human beings, we will be weaker. A tribe’s strongest bonds are borne in shared struggle and grief.
Our tribe’s tethers of concern and kindness are weak. Isolation and overwork has atrophied them.
“You never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
– Buckminster Fuller
Millennial physicians do not want to be Lone Rangers – we are looking for our tribe.
The machine should be worried. If we do not find our tribe within the House of God, we will look elsewhere. Some will look outside of medicine, sapping the machine’s workforce. Others, however, may simply build a different House, and it may just make the House of God obsolete.
Thank you High Plains MD for sharing your story. You can read more on his new blog about his story and fascinating perspective on being a former primary care physician who is now an itinerant critical access hospital doctor, medicine, millennials and the FIRE movement, all with a philosophical and mindful slant. He is definitely one of my people 🙂
In a world where we have the ability to connect to everything through social media and the internet, it often feels like we have connection to no one.
It doesn’t have to be that way.
As Brené Brown writes,
“We are hardwired to connect with others. It’s what gives purpose and meaning to our lives, and without it there is suffering.”
Real connection starts with real stories that turn into conversations.
Reach out and find your tribe.
If you’re struggling to find one, I’ve created this space for you here. Message me on Instagram, Facebook or Twitter or you can contact me via e-mail at m@reflectionsofamillennialdoctor.com.
You are not alone.
***
Photo of J rounding the corner to Mount Fremont Fire Lookout by Mount Rainier, WA.
Man, what a powerful story. For what it’s worth High Plains, I am sorry that you worked for people who didn’t care about you.
I cannot even imagine what that was like. It might be an online community, but I’d be happy to join any that you are a part of to help get your message out.
It is not the broken doctor thatneeds to be fixed, it’s the whole damn system. They preach resilience, and we will continue to have to push for change. Until we can’t. And then we will leave.
Thanks for being vulnerable enough to share.
TPP
I am sorry for your loss and how you were abandoned by your peers. The people who should be the most compassionate and understanding failed you.
I second what TPP said. Each in our own way, we are building a community of millennial physicians intent on being financially independent so that we can take back some of the power that those before us ceded to the system and to make decisions about work that are the best for our lives. We see the world differently than other generations and know that there is more to life than medicine.
~Kpeds
Outstanding piece. The “live to work” mindset is unfortunately still pervasive in Doc culture, and our overlords (and colleagues) use it to control us.
So sorry for the loss of your child and even sorrier (and angry) that you had to deal with it while juggling Mr. Jones prescription renewals and Ms. Smith’s abnormal chest x-ray results. 😢
Thank you all for your words of condolence, support, and encouragement. It has been a challenging year. M and I have had a couple back and forths about physician community and haven’t some to any grand conclusion on how to help foster one effectively.
All of our professional organizations seem solely focused on economic concerns and not on the underlying issue about bringing humanity and community back into medical practice, which I think would actually address a good deal of our economic concerns as well.
As far as the “live to work” mindset. I remember being able to tell that my colleagues and administrators were sort of in a “does not compute” mode as far as my reaction to work after my daughter died (which was to view it as something I needed to protect myself from, not find shelter in). I think very little in the culture is conscious, which is what makes all the more insidious and dangerous.
You can’t change a thought process you don’t know if happening.
I know exactly what you mean about brought to tears when you first read this story. It deeply saddened me too when I read it on High Plains blog yesterday. 🙁 It is sad that the whole situation had to happen and compounded even worse by how the supposed “colleagues” treated him.
I’m glad he left hopefully for much greener pastures.
When healthcare turned into corporate medicine, we saw the same devaluation of its workers (doctors, nurses, etc) as with any other corporation out there – we are now expendable and replaceable like cogs in a machine, without any regard for our humanity. High Plains MD’s story may be on the extreme end of this, but it’s happening step by step all over the country.
I respectfully disagree. I’m a Gen-X doc with 20 years of practice and I find that High Plains MD’s experience is no longer an outlier. Examples like this are becoming more of a rule, as big medicine is now being run by accountants and MBAs who are in the process of dehumanizing physicians, nurses and other health care workers. While PAs and NPs are referred to as advanced practice providers in my organization, physicians are now referred to as “providers.” When one of my physician colleagues’ spouse unexpectedly died, he was given 3 days off to grieve and then was required to returned to full duty. Not surprisingly, he was still tearful upon return to work and because our number crunching administrators thought that he should have manned up, he was sent to the state physician health program for evaluation. They diagnosed him with having a normal grief reaction but because this program was used as a punitive tool, he left the organization leaving a hole that is hard to fill with his 30+ years of experience as an ER physician and an Ivy League professor of medicine. All these stories may make our profession seem hopeless, unrewarding and unsustainable but there are tools available to help us physicians maintain our sanity and allow us to provide quality care to patients.
The first one is FMLA. Use it to take time to care for oneself and family.
The second one is a provider union. Our group contacted the Union of American Physicians and Dentists when one of our surgeons was placed on administrative leave and had her email locked out for a week when she wrote to other physicians about her issues with salary. The Union has already helped us physicians, PAs and NPs against unfair labor practices inflicted by our administrators.
That is absolutely awful. I had hoped perhaps High Plains MD’s experience was an outlier, but I’ve heard more stories similar to his after he shared his story.
To add to your tools, there is a new movement called #PhysiciansRise. I’ve seen it a couple of times on Twitter – the site is physiciansrise.com. It’ll be interesting to see where they take it, but there are groups who are starting to push back against these horrible administrative practices.