Dude? It's all I can say...Duuuuude. This thing sucks.
What I am talking about is the changing landscape of clinical expectation of the anesthesiologist. When I trained, I was a star student, a chief resident, and the only advice given at the time was to 'be more flexible'. Go along with the changing case assignments and just do whatever you are told.
I had a problem with that. At night, I'd call the patients, they would bond with me, the therapeutic alliance had been formed. They were counting on me to be the one to take care of them!
At UC, academic medicine, I worked part time and was happy. I was an attending, teaching residents, working with CRNA's in a trauma center. It was generally understood among the surgeons that our specialty is what it is, and it was realistic the expectations of what we could offer. This was both in obstetrics and in the main OR and the surgery center.
With the new chairman, came new expectations. I was told by SE that if I wanted to keep my job I needed to 'get a nanny'. I had to be at work by six thirty, ready at the bedside (first case would go into the O.R. at 7:15am, usually I had to be there by seven).
Then came the clipboards. People measuring times and productivity at the start of the day.
Then came the moving only MY heart patients to the farthest possible bed from the cardiac O.R. and clocking me. The other two cardiac anesthesiologists, no. Just me.
They knew I was a single mom and didn't have any help. They knew I wanted to raise my son, not to give that to someone else. They knew mornings were really hard now that my mom stopped watching him.
I found myself crying at work and wanting to drink once I got home. The new chairman from Yale was such a controller making waves that everyone, even the Korean OB anesthesiologist would go home and drink. He lost his beloved position as chair of OB Anesthesia too.
Then came the meeting with the chairman, and when I saw my colleague walking back to the campus after his meeting, and he gestured with a finger slashed across his throat I knew exactly what was up.
Was I happy at UC?
No. I didn't fit in. I didn't make as much money as the others (about half), money was always tight, and I couldn't really fit in to the clique at work. I'll never forget the stress LJ gave me. She took me out on Christmas Eve with her family, but pumped me for information about my colleague and former residency director KG. I wouldn't give it. And then they forced me to be on call on the last Christmas with my dad--but I got KG to cover. It was bad.
Then there was the time I couldn't go to morning weekly lecture, I had to do a case, it was emergency heart, and the defibrillator had it's electric cord missing! That was very, very scary. It never in all my years with the department (11 in all) had been gone. It was very unlikely to be an accident. It was a set up.
So I left.
I found solace and refuge in Little Saigon, covering for a woman who had breast cancer. I scrambled and found work at a seedy hospital. But my mentor heard of my plight, and got me a position where I have been since 2009.
In private practice the rules are different. You can never, ever get a wet tap on O.B. You have to be at the beck and call of the mothers--even if it's too late for an epidural (baby is almost here) you have to put it in. The nurses had power and wielded it over the doctors. And I had to stay in a windowless call room and lose sleep. Anesthesiologists are allowed only one emotion--cheerful and willing!
I was so depressed that Ross stepped in. One OB anesthesia call shift I wasn't needed and I never even came up to the labor deck. I just lay in bed the whole twenty four hours, under the covers, stressing over how and when they would call and what I would have to see--screaming women in labor? Cruel, judging nurses waiting for me to fail? He said, 'no more'.
So there was a thing with the OB nurses, to my boss, and they didn't like certain anesthesiologists, and we were out. I did poorly at the end because my mentor had been thrown out--I had no access to him clinically and he's an OB Genius. And I knew I could be thrown out like him because he was my mentor and close friend. My student and now colleague and friend of my mentor got thrown out. They were suing my boss. I had to become a corporation.
But with TG, the orthopedic surgeon, I had a hard time getting an inter scalene block. I can do them with a nerve stimulator, easy. But with the ultrasound it was really hard. A friend and I couldn't get it, and it delayed a case. He blew up, went totally ballistic and ran straight to my boss.
Never again could I work with TG.
In Private Practice the surgeons own you. They decide if you can eat between cases. I've had people tell me 'no' because they have to go to a meeting, or pick up their kid...I've been shocked because I wouldn't ask if I wasn't in desperation, and they said no. No compassion for me. I might as well be a horse that gives anesthesia.
TG was so unhappy he brought in his own anesthesiologist NZ.
One by one, over ten years, you can't keep surgeons happy one hundred percent of the time. You just can't. Not if you're doing your job and sticking up for patient safety. That's why we go through oral boards. Just for that.
Surgeons in private practice at my hospital can ruin your career on a whim. And they do. One wrong look, one wrong word, and they don't want to work with you. You don't want to listen in to their monologues about the minutiae of their life and take care of the patient? Tough shit. They want you to listen and be hanging on their every word. Or else they go to your boss.
But I struggled and persevered. Yesterday I found the lynchpin, that little piece of my confidence that had kept my wheels falling off ever since TG, HM, DB, KA, PF, SC, JK, and TL complained to my boss. I had no defense, the surgeons are judge and jury, and my boss has to cater to them. But with NZ and others being 'block jocks' gradually orthopedic services went away for me too. There's hardly any cases to do. I asked to do the block case and I got it. I did it. And it worked. Not only the popliteal block, but afterwards two more Gyn cases wanted TAP blocks, and my last surgeon of the day said her patient was AMAZED at what I did for her pain weeks ago when we worked together and I did TAP blocks. She had no pain for two days, and the patient said she has had ovarian cystectomy before elsewhere and it hurts.
My blocks work.
All that stuff my boss and the surgeons have been telling me, has been psychobabble designed to make me feel weak and insecure. It almost worked. But no more. I know in my heart I can do my job.
I also found out that another female colleague is going to have her hours cut. She's the one who complained about the short Vietnamese stealing cases (he does, we all know it, but she's the only one who doesn't let him get away with it. It went up to the medical staff and administration, with her as the bad guy. This is vindictive on the part of the short Vietnamese.)
What happened to me was no accident. I sensed it was punishment for my writing a letter whistleblowing about the late night robot cases and the lack of legal defense for any bad patient outcomes with the current staffing. But there was no explanation except for my boss yelling at me in the hall, weeks after the fact, saying horrible things about my skills, and conceding that I do take my call I don't give it away. If it wasn't for that he would have never put me on the schedule at all (fired me). I actually like the part-time, it's better. And perhaps something else will turn up if I look around hard enough for it.
I also know I deserve a life where I can sleep in my own bed, and I don't have to rent a hotel room, and I deserve to enjoy being a mom.
How to make that happen, I don't know. But it's been a huge turnaround. I can see clearly that the status quo isn't going to advance Spirit in Medicine. And with Medicare for All coming--one way or another--the job isn't what it used to be. My mentor and my colleague sold their practice to a mega-anesthesia group from New York for a nice fee, just because they see what's coming down the road.
I just spent time in meditation. Dr. Dao came to me and said he was so sorry. He invited me to tea with him and the Buddha. The Buddha said that games people play are games only if we play by the other people's rules and let them make up the game. We don't have to play, we are under no obligation, and to let all of it go. It helped a lot. Dr. Dao reassured me my skills were good, that he enjoyed working with me, and even more important, his patients were happy.
Today is a big day. I have lots to do.
I had been on the schedule in two places. I brought it up with the scheduler one month ago, and he said I was to work. But there are two schedulers. The other one crossed out my work name slot and put someone else's in. So I forwarded copies of the original email with the scheduler to my boss. He said he didn't want to deal with it. And to talk to the scheduler. I told him I did, in November, that this was a surprise, nobody said anything to me about it, and I was concerned. I also told him the short Vietnamese (by name) called me and told me about it. I apologized for bringing it to his attention.
Did I want to work?
No, not really.
Did I want to be all meek and submissive and let them do those changes on me without speaking up?
No.
I spoke up.
Our next schedule is due out, Jan, Feb, March. It is the one with the cut back hours for the other female. We have one VZ, banished to OB, but she doesn't mind. NN is getting her hours cut by a lot but doesn't know it yet. SL told KF who told me. EK and I are 'part time' but when we are short we are full time. But the story for me about today was is SA was on OB (she only does OB) then either EK or I must take the day off. SL is leaving to go to Florida and have a better job. Those are all the women in the department, except for ML, who is a grandma and works part time. Nobody gives ML any flak because she will bite your head off. But ML is leaving in two years. SA told me to lay low, not to fight my boss, and except for the stuff about today I have. I've been on time and no complaints. The pattern is the middle east clique and the vietnamese clique --both male--are lock-step with administration and the surgeons--to keep anesthesia the status quo--no breaks, no lunch, and work shifts twenty four hours straight (EK just did that on Wednesday night, working until 7 a.m.)
Life has so much more to offer!
It's great to be back in the saddle again. Kelly told me the stuff my boss says, is like the gas-lighting stuff her old boss used to say to her--meaningless, and designed to make you cower and submit. She thinks out of all the ones, I am the best, because I pay attention, and also, I talk but not all the time especially when it's difficult parts of the cases. I'm so glad she's my friend.
Let's see where this one takes Reiki, and my future!
clap! clap!
Aloha and Mahalos,
Namaste,
Peace,
Ross and Carla
The Couple
From Ross--Carla's cousin sent this to her and I want to share:
