What Could We Have Done Better….Part 1

Everything that comes after in this blog will be informed by this experience.  So, I feel that I have to start with it.

Scene: My last medstaff meeting in my previous job after making my resignation official:

One of my partners: Can you elaborate on why you are leaving and what we could have done better to help keep you?

Me:  I have found that emotional intelligence is not valued here.  I feel less human because of the year I have spent here.

Same Partner: That is very sad.

Other partner: Can you elaborate on what you mean by that?

Me(tears starting to form):  Not right now.

Later that day I was told by our clinic manager that all of the medical staff told him that they had no idea I felt that way.  I felt my point about emotional intelligence proven.

Stepping back a few months…

I had been in this practice for almost a year and we were expecting a new baby.  Because of how tight the call schedule was, I had only opted to take the 2 weeks off around the suspected due date.  I had repeatedly asked the administration and my partners to arrange for back up coverage because things often do not go according to plan with babies.  Things did not go according to plan.  My wife was induced at 37 weeks (3 weeks early) for polyhydramnios.  Our beautiful little girl was born and required significant resuscitation, ending up in the NICU on a ventilator with a feeding tube.  I called and told my partners not to expect me back until further notice.

The news didn’t get better.  She failed extubation twice, she didn’t have the strength to swallow or breath without mechanical support. We never got a diagnosis, which wasn’t surprising or upsetting.  Diagnoses rarely help patients as much as they do doctors.  A rose by any other name would still require ventilator support.

We started hospice/end of life discussions with our neonatologist.  That same week my partners called to see if I could cover call on a Saturday because “no one else was available.”  Not like I had anything better to do….(I refused).

We took her home on hospice.  She was extubated on our front deck in the sun and she passed peacefully.  It was beautiful, and terribly, heart-wrenchingly sad.  She was three weeks old.  We cried, a lot – we still do.  We a took a week and scattered her ashes on a sacred mountain.

Rachel Weeping
Photo Credit: By Charles Willson Peale – Philadelphia Museum of Art, Public Domain, https://commons.wikimedia.org/w/index.php?curid=7365050

I decided I should ease back into work.  It had only been 4 weeks since she was born, less than 2 since she passed.  It was probably too soon, but I figured that I would have to sooner or later and easing in would be best.  No one gives you a guidebook for navigating the death of your newborn child.

I felt that I had communicated that I wanted to ease back into work.  My partners felt that it was appropriate for me to take back on my full call burden.

This included the following: 120 hours of ED call within 7 days including Thanksgiving.  The 72 hours of call before 8 AM on Christmas morning, and the 24 hours following Christmas. I was still the f***ing new guy, apparently it didn’t matter that I had lost a baby with whom my wife and I were supposed to spending our first holiday season, but weren’t.

When I tried to back off and protect myself, here is a greatest hits of things I heard:

—–

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 could have planned 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.

——

Same partner as above in a conversation about me possibly switching to do just hospitalist/ED work for a time: 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.

what could we have done better to help keep you?

I guess you could have just been the human beings and caregivers you say that you are….

9 thoughts on “What Could We Have Done Better….Part 1”

  1. My heart sank as I read this post. I am so sorry for your loss and it really is unimaginable for anyone who hasn’t gone through it.

    On top of that, the fact that the lact of compassion by your supposed colleagues is a bit appalling.

    I had an awful experience with my daughter (I lost her for 6 years straight not ever seeing a picture or speaking with her) because of lies my ex told during a divorce (my ex later was diagnosed appropriately with mental disorder and I won my daughter back but the time was I missed out was gone forever (age 4-10). Even as painful as that is, it pales to what you went through.

    1. Xrayvzn,

      Thank you for the kind words. I have been doing a lot of grief work over the last year and one thing I learned is that grief is not quantifiable. I am very happy that you got your daughter back. While I may never get my daughter back (at least physically), I also can’t imagine what it would be like if someone else’s actions had led her loss. She was who she was, unfortunately that precluded eating and breathing without tubes – but I can’t blame anyone for that and it would be so much harder for me to live fully and appreciate the gift of her life if I could fall back on anger.

      Not more, not less, just different.

  2. Thank you for writing.

    I’ve read through your entire blog, (back to front…) this morning waiting on the sunrise.

    I grew up on the Llano Estacado…

    (thank you in advance for your tolerance with my multiple comments…but you have so well described the ills of modern medicine…many of your points have been lived out in my life).

    I am so sorry about the loss of your daughter.

    I’ve mixed tears with my morning coffee today.

    1. Thank you for reading and the kind words. Maybe eventually we’ll be able to start taking about some treatments for the ills of modern medicine (other than shiftwork – which really feels more palliative than anything).

      You are the first commenter who has mentioned any connection to the High Plains. It is not a well-known area and not aggressively beautiful in the way mountains and canyons are, but is a special place nonetheless.

  3. Heart breaking. The first group that I was in just of of residency would of done this as well. One of my partners 15 year old daughter committed suicide and he took no time off. This will never heal but will get some better with time. I had OB patients that had term stillbirths that still cried about them 20 years later.

    1. Thank you for reading. I had an extremely supportive and (what I now realize was abnormally) emotionally intelligent residency cohort. I was shocked by the way my partners reacted. It just made no sense to me, and I am sadden to learn that it is more common than I realized in medicine. I was clearly protected in medical school and residency to a point from some of the most toxic aspects of medicine.

      We actually went out of our way to have family and friends come and meet her when she was alive because we wanted to be able to remember her as a person with others. She was obviously not stillborn, but the fact that we have a special word for babies who die in the womb kind of depersonalizes them. So, we spent a lot of energy helping those we love feel her as a person, as we did. It turned out to be important.

      It has already gotten better. We obviously still feel the loss greatly, but with time we are able to see how her life has given us gifts we never have had otherwise. It is made easier by the fact that her health problems were not anyone’s fault and were inherent to who she was. Increasingly, wishing for to have been able to breath and eat independently feels like wishing for her to have been someone else entirely, which we would never want. It is a strange and special process.

  4. I am appalled but sadly not surprised. In many ways medicine is just a business like any other and we are cogs in a machine. Use us up until we break then replace. We are always hearing that new docs need to be careful when signing their first contracts. That you can’t trust other MDs you work for just because they are MDs. It is all sad and disappointing. The way you were treated is horrifying. All the best to you and your wife.

    1. Thank you for the well-wishes. Oddly, I think it would be easier for me if I could just chalk the whole experience up to a group of bad apples. Sadly, that doesn’t seem to be the case. I think the situation I found myself in was extreme, but emblematic. It makes it difficult to see a path forward in organized medicine.

  5. My reactions are similar to those above. Sadness at the loss of your daughter. Anger at the insensitivity of your partners. Also, grateful for my current work situation. I have not experienced the issues that you have but for the minor bumps in life I’ve been fortunate to have partners who will swap calls/cover. I’ve also done the same for them. When I advise residents I always tell them the number one thing to look for in a job is your boss and colleagues. Look at everything else after that.

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