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….