Sunday, November 25, 2012

The World Became a "Yes"


     When I was in medical school, I bought myself several pairs of pants at the Gap. Because I despise shopping, I found a style I liked, and purchased four identical pairs in different colors, thinking my surgery residency interview wardrobe was now complete. At $48 a pop, not on sale, this was an expensive investment. But, I needed to start looking like a doctor, instead of a hippie-freak, and as much as I hated dressing up, my wardrobe of ratty jeans, Birkenstocks, and rock T shirts was sorely in need of an overhaul. Interviewing for residency is a complicated business. It's not enough to be smart, you also have to look and act it, projecting professionalism, personality, and poise under pressure. Because of the way residency matching works, you really have to sell yourself, especially if you're a woman in your mid-30s, with a state college nursing background that's accompanied by a startling absence of peer-reviewed publications, research experience, or fancy credentials, who happens to be vying with brilliant scholars nearly half your age for a coveted general surgery spot at Vanderbilt or Emory University.  Here's how "the match" works. You rank each program where you've interviewed, the programs rank you, and when the numbers are crunched across the nation the third Thursday in March, you'll land a spot based on how those two variables match up. Needless to say, the likelihood of being disappointed is extremely high. It doesn't matter who you are or how much influence you think you might have, there's just no manipulating the system. To make matters worse, not everyone will match. This unfortunate circumstance necessitates a day of its own, known as Scramble Day, in which unmatched candidates hustle for vacant residency spots.
     Even though I'd tried the pants on when I was at the Gap, once I got them home, they just didn't fit. They were all too big. I tried cinching them at the waist with a belt, which accomplished little more than bunching them up in a most unflattering way, exposing me to the grave threat of camel-toe. I even tried washing one pair to see if they'd shrink, but that didn't work, either. My attempts at reconciling this Apparel 911 left me with four pairs of pants that didn't fit, one of which now sported a tiny bleach spot. Deeming the pants unwearable, I folded them up and put them back into the bag with the receipt. They sat in the guest room closet for close to two months until I casually mentioned my ill-fated purchase to Rana, my shopping-savvy friend and fellow medical student. She scrutinized me in utter disbelief before exclaiming, "How is it possible that you've made it all the way through medical school, and you can't return a freakin' pair of pants to the Gap?!" It certainly was embarrassing. For some reason, I'd always had a hang up about returning items to the store. Luckily, I don't like to shop. It sounds ridiculous, but I equated approaching a customer service representative to inquire about a refund or an exchange with standing before a firing squad--I'd be at someone else's mercy, risking humiliation, rejection, and bodily harm, most notably to my Achilles' heel, a disabling self-consciousness engendered by my fragile, fragmented ego. What if they said, "No"?  Recognizing that I had a serious mismatching of assertiveness in the intellectual and common sense departments, Rana informed me that, on Saturday, I was going to march myself into the Gap to return those pants, and that she was coming with me.
     At ten o'clock that Saturday morning, Rana whisked me off to the mall. On the way there, we practiced the entire scenario: walking confidently into the store with the ill-fitting pants, assuredly summoning the customer service person, and successfully completing the return transaction. She made it sound so easy. Moments after we entered the Gap, headed straight for the service counter, I froze. I couldn't do it. The dread involved in returning those pants was just too overwhelming. I stood there, motionless, a future surgeon afraid of my own shadow. "Give me your credit card and come with me," Rana instructed. To the woman behind the counter, she simply said, "I need to return these pants. They are unsatisfactory. Here's the receipt." Within seconds, and with no questions asked, the pants were returned and my credit card, refunded. Rana was graceful about the whole fiasco. "Being assertive isn't about being aggressive or bitchy; it's about getting your needs met."
     That was twelve years ago. Since then, in addition to returning items that don't fit, I've arbitrated my divorce, negotiated contracts and warranty extensions, confronted unprofessionally-behaving colleagues, and begun addressing obstacles to communication within my family. I've found a suitable exchange, trading my ego for a voice that's confident, consistent, and congruent, one that enables me to be my own best advocate. The inner me finally matches the outer me. Although I still fall off the wagon from time to time, taking things too personally or letting people get under my skin, I'm aware of it now and can jump right back on. Speaking up for myself actually permits me to listen more receptively to others. I readily acknowledge that the world would be a boring place if I was right about everything, a self-deprecating quality that prevents me from taking myself too seriously. I also embrace the philosophy that opinions are like dirtbuttons...everybody's got one. I don't take anyone very seriously. Life itself is serious, but it's way too short to waste, fearing the unknown. Here's what I've learned about life so far: when I quit being afraid of "no," the world became a "yes."

P.S. I matched in general surgery at my first-ranked choice, Emory University, and was the first person from my medical school accepted into Emory's general surgery program. A year later, I switched to anesthesiology...lifestyle, lifestyle, lifestyle :-)
Our medical school graduation. From left to right, I'm on the end of the 2nd row. Rana is on the 3rd row, third from left.













Saturday, November 17, 2012

A Fortuitous Fracture In Time

     Browsing through Facebook this morning, I came across an e-card that several of my compadres in healthcare simultaneously posted. It features a surgeon, holding a scalpel, and reads: "I work long hours. I wear bodily fluids that aren't mine. I work weekends & holidays. I get screamed at & have my hands in other peoples' orifices. Tell me again how hard you work?" Aware that I was breathing a sigh of relief, I grabbed my second cup of coffee. The realization had just hit me...I've spent the last 27 years providing patient care in various capacities as a tech, nurse, and physician, and this is the first year I won't be barricaded inside a hospital for Thanksgiving, Christmas, or New Year's. As long as I've been working, I've worked nights, weekends, and holidays, while everyone else important to me got to enjoy being at home and sleeping in their own beds. No one wants to be on call. No one enjoys call. Therefore, I feel no shame in admitting that I've hated every minute of it, especially anesthesia call, where you're always someone else's bitch.
     One year ago, I was recovering from what I then considered the catastrophic loss of my job. On November 2, 2011, just five days before my 49th birthday, my boss, a physician-attorney, nonchalantly informed me by telephone that I had to leave our practice because A) a surgeon had complained I was too rigid, and B) the overpaid CEO of The Miracle Center* didn't approve of a humorous Facebook post I'd written about the computerized medical record software the hospital had recently adopted. Why and how Kurt Stinkypants** was alerted to my Facebook page remains a mystery. Although I was never privy to the identity of that whiny surgeon, my best guess is that it involved a cancelectomy*** of some sort. In fact, I'm relatively certain it was the same general surgeon who wanted me to put a non-toxic appearing two year old boy to sleep for incision and drainage of a thigh abscess, even though the boy had a stomach full of chicken biscuit and didn't require emergent surgery. He didn't want to postpone the case until later in the evening, so he cancelled it, and then went crying to administration. Waaaaaaaaah! 
     Although I'd just been disposed of like a used nitrile glove, I was expected to continue working for the next 90 days, until a more suitable replacement could be found. I agreed to this under one condition: that I would no longer take any call. Right after hanging up, I sent my boss, who quelle surprise! was out of town, the following email:
     Just to clarify, my understanding is that the administration is upset with me over a FB post regarding Cerner, and that some of the surgeons think I am rigid, and that is why I am being asked to leave the practice. This essentially equates to a hostile work environment, and obviously, I have grave concerns about continuing to provide services there. I will be willing to work the remaining 90 days, provided I do not take any call, effective today. I think it is shocking and wrong that a benign FB post about an electronic medical record, which is not unique to this hospital, leads to me being asked to leave without an opportunity to defend myself.
     I checked and re-checked my e-mail and cell phone a zillion times that evening, but never received a response. My next scheduled 24 hours of call was Saturday, November 5th, and as far as I was concerned, Boss Man was looking at some major restructuring of on-call responsibilities because I was DONE! I don't know how I did it, but I went into work the next morning. I was still in shock. Everything felt mechanical, a slow motion masquerade of once-familiar faces and surroundings, suddenly distanced by a fortuitous fracture in time, the discontinuity of which threatened to vaporize every last shred of dignity I possessed. Somehow, I made it through that day. I told a few co-workers about what had happened, and it wasn't long before word got out that, come January, I'd be leaving Rome. I spent the remainder of that afternoon and evening, crying inconsolably and freaking out. What was I going to do? At my insistence, Spartacus had just quit his job, and in three months, I would be unemployed as well. Rome was a small town, saturated with anesthesiologists, and unless I wanted to commute like I did when we were still living in Atlanta, we were going to have to move again. 
     On November 4th, I finally received this e-mailed response from my boss:
           I cannot permit this. You are obligated to cover your call as scheduled. You cannot simply announce to your colleagues that you’re not going to take your call and lay the burden at their doorstep. The consequences of this action will be dire! 
     Long story short, I immediately plunged into a mercifully brief, albeit suicidal, depression. I showed up for my 24 hours of call the next morning, and I've gotta say, there's nothing quite like Saturday anesthesia call at the Miracle Center to make you seriously consider jumping off a bridge. It's like picnicking in hell. My emotions were all over the place, vacillating between rage, humiliation, and utter despair. I couldn't stop crying. I was literally running on fumes from the few hours of crappy sleep I'd managed to snag, courtesy of my last remaining 10 mg Ambien tablet, which I'd desperately rationed into four nearly inert fragments. I've never been that distraught before, and it scared me. I think it scared my partner, Steve, too. Because my boss had called all the partners in our practice, telling them I was refusing to take call, Steve had taken it upon himself to cover for me in case I decided not to come in to work. Someone had to take care of the patients. He took one look at me, and my anguished hysteria, and told me to go home. On November 11, I formally resigned.
     My last call was Thanksgiving weekend, the oh-so-delightful Friday/Sunday combo. As you might imagine, it was a suckfest, but by then, I'd at least gotten through the worst of my depression, my anger having begun its dissolution into a resolve so transformative and compelling that life hasn't been the same since. It finally dawned on me that I wasn't trapped. For years, Allen, my dear friend and former  colleague had patiently listened to me complain about feeling trapped, like a caged bird, both personally and professionally. Even though I wasn't happy, I'd convinced myself that I couldn't be happy anywhere else, that I was stuck. "Sweetheart," he'd say reassuringly in his refined South Carolina drawl, "you are never trapped. You can do whatever you want to do! You just have to believe it." 
     I'm not sure why it took me so long to grasp the importance of Allen's message that indeed, I was indomitable. Better late than never, I suppose. In my case, it took a life-altering event for his wisdom to crystallize into awareness. As I walked out of The Miracle Center on that chilly November Monday morning after completing my last call ever, two things occurred to me: I wasn't trapped, and perhaps even more importantly, I've always been free. 
The Reverend Dr. Allen N. Gustin, Jr. (left), who became ordained just to marry me and Spartacus!  This photo was  taken moments before our wedding on October 24, 2009. 


*facility name changed
**CEO's name slightly modified
***cancelectomy: when a surgical case is cancelled for various reasons, not the least of which is concern for patient safety

Sunday, November 11, 2012

The Ride Itself

     Sunday's shy mid-morning light dapples my drafty kitchen with a warmth so delicious I can almost taste its honeyed rays. Alternately grey and blue, the sky can't seem to make up its mind. Neither can I. What exactly does it mean to be accomplished? Looking around the room, I see my framed diplomas and certificates displayed on the wall, juxtaposed against a painting that's unfinished, books that are half read, and boxes that are still unpacked from our move almost eight months ago. Why don't I finish the things I've started? Why do I reinvent myself every ten years? From my perspective, looking good on paper isn't the recipe for success it's cracked up to be. Sometimes, people with the most brilliant educations and lofty lists of achievements are also the most malignant, selling out every last shred of integrity in their insatiable quest for status and power, all for the sake of "being someone." There's definitely something to be said for simplicity.
     For the last few weeks, I've been baking our bread instead of buying it. Although I'm using a breadmaker, which the baking purist in me automatically denounces as a form of cheating, I find it deeply satisfying to turn a fragrant, brown, homemade loaf out onto my cutting board, ready to be sliced into thick chunks, slathered in butter and dipped into soup, or made into hearty sandwiches. It's like returning to a simpler, less complicated space in time where I get to enjoy both the process and the fruits of my labor with equal intensity. The bread machine isn't foolproof, though. Factors such as ambient humidity, the actual weight of the flour, and the type of yeast all have an impact on the final product, the interplay between which is easier to assess when making bread entirely by hand, underscoring the importance of understanding that technology is a complement to observation and experience, not a substitute for it. I happen to love troubleshooting recipes that defy logic and reason. Suffice it to say, I've tweaked the manufacturer's recipe here and there to achieve results that I consider desirable. If I do say so myself, this bread just keeps getting better.
     A couple of days ago, I received a letter from my brother, Adam. He's spent the last 12 months of his life in a prison in south Georgia, doing time for a non-violent offense which violated the conditions of his previous parole for drug-related charges dating back to 2000. It was a good letter, full of hope, resolve, and determination. "I've made the absolute best of this bad situation...and come to terms with who I am and who I want to be. I can't go back and make a brand new start, but I can start from now and make a brand new end." He's living proof that a few changes in ingredients and technique can transform a recipe for disaster into a happy accident. On December 17, he'll be released, and will start life anew.
     Who we are and who we want to be...can any of us really answer these questions, without categorizing ourselves in some way? Can we cease being who we already are, or become who we've never been? Are we permutations of an original recipe or are we sophisticated fakes, chock full of preservatives and artificial flavors? And, if we start from now, is it possible to remain there? Isn't life as much or more about the ride itself as it is about where the ride is ultimately taking us? Just like my bread--a recipe still  in progress--life, too, has an expiration date. Enjoyed in the moment, however, it always seems fresh.

Saturday, November 3, 2012

Greetings from Dog Hair City

     After spending all week trying to determine exactly what's been wrong with me, I've finally figured it out. I've been living in that special hell known as Dog Hair City. A massive sucking vortex of domestic unpleasantry and inconvenience--specially designed for mothers and wives--Dog Hair City bitch slaps you, grabs you by the hair, and pulls you kicking and screaming into a parallel universe where chaos flows like a squeeze bottle of pancake syrup in the grubby hands of a toddler, everywhere but on top of your waffles.
     It all started last Sunday when Spartacus came running breathlessly into the house while I was making us some lunch. "Man, I've just been watching this chick who's been sleeping in that car that was parked out front all night. She gets out of the car, throws on a backpack, and leaves a giant sword on the roof with a blade THIS long, like the kind for lopping people's heads off! Then, she disappeared down the street!" I got so caught up in his excitement that I forgot it was the weekend before Halloween. He pointed at the window by the kitchen sink, where I was washing dishes, "Look! You can see it from here!" Indeed, there was a sword sitting on the roof of her car, eliciting strange looks from passersby walking their dogs. "All right," I said, "I'm gonna go have a look. We better take some pictures." Armed with my camera, I threw on a sweater, and ventured outside to survey the chick's abandoned car. Once I made sure there was no sign of her anywhere, I gingerly approached the vehicle and snapped a few pictures. "Wait a darn minute! Is that thing even real?!," I queried, finally having come to my senses. Motioning to Spartacus, who was standing a few feet away as if the car might explode at any second, I grimace-whispered, "Come over here and see if it's real!" It took him several agonizing seconds to actually make contact with that damn sword, during which I fretted, "Now, his fingerprints are gonna be all over it!," envisioning our mug shots after a fracas with the police. "It's plastic," he reported. And, that's when the vortex sucked me in.
     The rest of the week was an ongoing parade of irritations, the least of which was the self-perpetuating collection of rinsed dirty dishes, left sitting in the sink. Apparently, having two X chromosomes is a prerequisite for  placing such items into the dishwasher, as is returning them to their respective areas of storage once they are clean. I've also discovered a syndrome called Clean Dish Neglect, in which a dishwasher full of hot, freshly washed plates, glasses, and silverware fails to trigger an intrinsic mechanism for detecting obviously scoured and sanitized surfaces, paradoxically prompting sufferers of this condition to initiate the otherwise unheard of dishwasher loading procedure, e.g. placing one's used coffee cup amidst those that are quite visibly pristine.
     The simplest observations seem to elude XYs. It's ironic that "Gee, look at those brown streaks. This toilet needs scrubbing!" or "There's a fine layer of dog hair covering every square inch of this house; it's time to dust and vacuum!," are such foreign concepts that they evoke absolutely no reaction, yet "Damn! There's a smudge on my rear bumper!" prompts an immediate visit to the car wash. Replenishing household necessities, such as toilet paper or milk, also tends to be an afterthought, much in the same manner as handwashing, hanging up wet towels, or putting the seat back down.
     For about two weeks now, I've become increasingly more aggravated over the racket known as emissions testing. The tag renewals on the three vehicles I own are due on my birthday, which is November 7, and because I've moved from a city which doesn't require emissions testing to one that does, I can't just complete these registrations online: they have to be recalculated and prorated. I have to go in person to the tag office with proof of residence, and both my sons' cars have to pass emissions inspection. My son, Nick, is driving my old 2005 Honda Civic hybrid, a car which now has 94,000 miles on it and runs perfectly. When I asked him to get his inspection done a couple of weeks ago, he told me that for some time now, both the "check engine" and "IMA" (integrated motor assist--the hybrid battery) lights have been on, but that he'd googled the diagnostic codes he'd obtained at Auto Zone, and determined that this was some type of non-emergent problem. Needless to say, I was annoyed that he didn't mention this problem to me before now. He showed me a youtube video of a guy who'd cleared those same codes by installing a new 12 volt battery and air filter. It seemed like a legitimate solution; his car was running well, and the IMA battery was staying fully charged. Why not give it a try? Since I'd recently received a notice from Honda about the hybrid needing an emissions-related software update, we decided to take the car in to the dealership after replacing the battery as the video suggested.
     Long story short (and $120 later), the new battery idea didn't work, and neither did the software update: those pesky lights stayed on. It's hard to imagine how a hybrid battery could affect emissions testing, but I'm told it does, and there isn't an inspection site that will run the test with a "check engine" light on anyway. If you're stopped while driving a car with expired tags, it's easily a $200 fine. Time was running out, and unfortunately in this city with its half-assed public transportation, you've got to have a car to get around. To make matters worse, the dealership found a transmission-mount problem--a $366 repair--as well as only 2 mm of brake pads left on the front axle. Yes, in Dog Hair City, you can't win for losing...it's always something.
     I was more than a little irate that the dealership had installed the software update and assured Nick that everything was fine, only to receive a text message from him at work the next morning saying, "The lights came back on." WTF?! He took it to a service station and had them run the diagnostic codes for those lights, and although the emissions codes were now cleared, the two most dreaded codes of all, those signaling "premature hybrid battery degeneration" were still present. Anyone who owns a Honda hybrid knows this is a $2500 to $3500 fix. Anyone who owns a 2003-2009 Honda hybrid also knows that there's a huge class action lawsuit regarding fuel economy and IMA battery warranty-related issues on these vehicles. Anyone who knows me knows that as much as I despise conflict and confrontation, I can resort to full-on bitch mode when the situation gets desperate. This situation was about as FUBAR as it gets.
     First, I called the dealership to register a customer service complaint. They should have run the codes after updating the software to confirm that the "check engine" and "IMA" problems were indeed resolved. After leaving a rather long and rambling voice mail rant for the service manager, I looked at the car's original warranty. As I suspected, the IMA battery was only covered up to 80,000 miles. I reviewed the class action lawsuit and did some googling, and learned that Honda had extended the battery warranty to 100,000 miles in states like CA and NY, which presumably contain the highest concentrations of hybrid cars. Although Honda agreed to extend the battery warranty for an additional 12,000 miles as a result of the lawsuit, at 94,000 miles, we were just outside of it. Basically, we were screwed. Unless I could somehow get a 100,000 mile warranty extension or register the car in a county that didn't require emissions testing,  a practice which borders on fraudulence, Nick would be risking a sizable fine if he got stopped after the tag expired.
     I could see where this was going. Either I was gonna pay $3k for a new IMA battery, or we were going to be scrambling to trade Nick's car in for something that'd pass emissions. Because I don't like dealing with middle men, I went straight to the top, and called Honda headquarters. In a recorded conversation, I made what I thought was a good case for them to consider extending my warranty to 100,000 miles, namely the fact that I've been a loyal Honda customer for the last 20 years, and that Honda had already extended the warranty in select states. It was a magnificent waste of time and breath. After a brief "conference" with the powers that be, I was informed by the woman with whom I'd been on hold for 20 minutes that "there is nothing we can do to assist you," as well as "No, there's no one else for you speak with here." Click. Believe me, I was seeing red at the end of that conversation. Just as I was googling Honda's CEO so I could email him a scathing letter of complaint, I received a call from the service manager at the Honda dealership where we'd initially taken Nick's car for the software update. I could tell that he was pleasantly amused by the VM I'd left him because he was laughing good-naturedly. He told me to have Nick bring the car back in to make sure that the correct software update had been installed, and that he would contact Honda's regional manager on my behalf to see about extending the IMA battery warranty. "Believe me, we deal with this issue all day long. I'm confident that Honda will cover all, if not most of the battery replacement." Professional and reassuring, he restored my faith in customer service. Now, all we had to do was wait.
     Because we are short-staffed and busy, I worked extra this week, providing me with welcome diversion from vehicle-related woes. Even so, I was still irritable and short-tempered. Minor nuisances that I'd otherwise overlook, like dog hair on the coffee table and unwashed dishes in the sink, were magnified into mini-disasters of epic proportion, threatening to coalesce into one huge catastrophic meltdown. I tried to remain in the moment, but the moment sucked. Thursday afternoon, as Nick was making himself a smoothie, the Vitamix blender started smoking. It's an expensive high horsepower blender, which fortunately is covered by a seven year full warranty, and both Nick and I use it several times a day. I guess all that frozen fruit overwhelmed its functional capacity. As I started launching into a sanctimonious lecture to Nick about how to correctly layer wet and frozen ingredients so this wouldn't happen again, he got a call from the Honda dealership. "Mom, Honda's going to cover the cost of the battery. All we'll have to do is pay $325 for the labor." Hallelujah, maybe miracles DO happen! Either that, or my persistence paid off.
     As mysteriously as the sword-wielding chick appeared and vanished, so did Dog Hair City. Well almost. I still woke up this morning to a house in dire need of dusting and vacuuming. I dreaded the thought of spending Saturday morning, cleaning. Spartacus must have read my mind because the minute he rolled out of bed, he made himself a coffee, and immediately started vacuuming and taking out the recycling like a mad man. Then, he went out to hit some golf balls, but not before placing his mug into the dishwasher with all the other dirty dishes :-)
That chick's scarily realistic-looking plastic sword.