It’s all about the “V” word……

Wow.

It’ s been over a year since my last post.  Apparently, I am one of the worst bloggers ever.

But you have to admit, it’s a little challenging to have had an active blog about leaving clinical medicine, and then go back to clinical medicine.  It leaves you with not so much to say.  I’ve actually considered stopping the blog altogether, since the entire reason for me starting it has pretty much vanished.

Except that I’ve realized that a) I really like writing, and b) maybe the blog just needs a slightly different focus.  Perhaps a focus on the path out of medicine just needs to be a little broader and include the road back.

So here it is.  I am dusting off some serious cobwebs.

It’s been a year and a half since I came back to medicine.  At first it was very tentative.  I started back at one day a week just to give it a shot, fully expecting that it would be the same misery as before and I would be out within 6 months.  Which is course is not at all what happened.  I’m now at 60% time (with my chairman constantly begging me to do  more) and having to train another provider to help handle my patient volume.  And I actually chose to do this.

I recently finished the longest week of work I have had since coming back to clinical medicine. I had a family emergency and a conference all converge around the same week, and ended up rescheduling two days of missed work into an already full week.  It was long.  It was incredibly tiring.  I was very glad when I finally got into my car on Friday evening to drive home.

And yet, it wasn’t a bad week.  It actually wasn’t even an ok week.

It was a really, really good week.  Yes, I was exhausted and completely ready for dinner out with a self-medicating glass of wine.  But I was just tired from working hard at an unbelievably rewarding job.

I’ve had a ton of time to think about what makes my current situation so ridiculously different from my old job.  I’ve blogged about the concrete differences that make my new life so very different from my old.  It’s very multifactorial, and certainly not simple.

Except that now, having gotten plenty of time and distance from my old job (and really, my old life), it actually is kind of simple.

When I look at all the different factors that are involved in loving my current work, they all have one thing in common.  From a truly exceptional chairman and an outstanding support system and dedicated nurse, to things as simple as having a nice office with plenty of windows and reserved doctor parking in the garage, all these reasons essentially boil down to one simple factor.  At first I thought it was people liking me, but I realized that plenty of people liked me at my old job, and I was a miserable wreck.  I thought it might be that now I am respected, but no, I had plenty of respect where I was too.

Then I realized – it’s the “V” word.

The reason that everything continues to be unicorns farting rainbows where I work a year and half after starting is that, after all this time, I am finally VALUED.

 

And lest I sound the least bit bitter about not being valued at my previous job, I fully realize how difficult this can be to achieve.

I think it’s extremely easy to confuse being valued with other ideals, such as being liked or respected.  They certainly share certain attributes, and we all feel good when we experience any of them.  I recently drank the Koolaid and read Sheryl Sandberg’s Lean In.  For those of you who have only just joined the human race, Sheryl recently became the COO of a teeny tiny social media company called Facebook.  She wrote a very poignant (and controversial) book about women breaking into and taking on high powered positions in major companies.

Did I agree with her 100%?  Of course not.  And there were definitely parts of the book I didn’t relate to, such as having children and balancing all that out.  Which is clearly an entirely different blog for an entirely different person other than me to write.

But Sheryl’s book was amazing.  Some of those pages felt like she was writing them specifically for me and me alone.  I won’t go into excruciating detail if you haven’t read it….ok screw it, I’m totally going to talk about what I thought was the best part of the book. Sheryl has a chapter on career paths, in which she discusses a phenomenon called “The Tiara Syndrome”.  Yes, it does do some gender stereotyping, which Sheryl is very graceful about addressing in her book.  Basically, women in general tend to function similarly when it comes to their view on success at work.  We roll up our sleeves, put our heads down, and do really, really good work.  And we keep doing good work.  And we do some more good work.  We don’t promote ourselves, we don’t draw attention to all the great things we are doing, we just work.  Because if the work is good enough, and we do enough of it, someone will eventually notice what an amazing, wonderful job we are doing, and come over and plop a tiara on our heads to thank us for all of our efforts.

TAAAAAA DAAAAAA!!!!!!    

 

I was absolutely, positively, 100% a tiara syndrome devotee.  And let’s be honest, half of getting through a clinical medicine residency is picking up your pom poms and cheerleading your way through all the fatigue and the stress and the trauma.  We train for YEARS to roll up our sleeves and put our heads down and work.  And when one of our attendings tells us we did a good job, it’s like winning the lottery.

The problem is that the model for getting through residency is nothing close to the model for having a fulfilling and successful career for the rest of your life.

In my old job, I was a total tiara girl.  I started a specialty clinic during my residency and grew it from one family to 5 families to 15 (headdownworkworkwork).  And I stayed on as faculty after I graduated and continue to serve as clinic attending, and taught residents, and published in peer reviewed journals (headdownworkworkwork), and organized conferences, and grew my clinic to 50 families to 100 to 200 (headdownworkworkwork), at which point with virtually NO help and NO support staff and NO meaningful salary, I completely imploded.

Was I liked?  Absolutely.  People LOVED me.  Was my work respected?  Definitely.  The residents gave me teaching awards, students would come back for a second elective rotation with me to learn more, colleagues would proudly laud my achievements to other colleagues.

Was I VALUED?  No.  No sir, I most certainly was not.

Because here’s the thing about being valued.  (And, in general, women tend to do this more than men.)  It’s super easy to confuse being valued with being liked.  We get the warm fuzzies with both being liked and valued.  They can look deceptively similar at first glance.

Here’s the catch.  To put it bluntly, you can be extremely well liked by your colleagues, and still have promises made to you that are going to be broken, be assigned a terrible salary that doesn’t even come close to acknowledging COLI let alone acknowledge the work you do, made to feel like no matter what you do it’s never enough, and be put in a situation with no help and no real way to succeed.  You can be the belle of the ball socially and work can suck suck suck.

As much as we don’t want to admit it, the reality is that it is simply not enough to pat me on the head and tell me I’m doing an exceptional job, and throw me peanuts to survive on.  And for some reason, historically women (in general) have tolerated this much more so than men.

I don’t mean to digress into a gender inequality in the workplace blog (there are plenty of those out there already, and did I mention Sheryl Sandberg’s book?)  This is about recognizing what you need as an individual to succeed.  Personally, it took me quite some time to figure it out.  I need to be truly, honestly, and tangibly valued.

Let me be clear – this is not at all solely about a paycheck.  Ironically, because I’m a generalist who has specialized and am now working in a surgical department, I am BY FAR the lowest paid faculty in the department.  I don’t cut into people for a living (God bless those of you who do and do it well), and my paycheck shouldn’t reflect that I do.  But I will tell you one thing: as an academic clinical assistant professor, I am making a very, very nice salary.  And my chairman is thrilled to give it to me.  It’s like every month, there’s a little subliminal message from my department in my bank account saying “Hey Lumi, you are totally worth it!  Thanks!”

But the salary is the tip of the iceberg.  Ironically it’s the small things that really add up in terms of feeling valued.  When I pass my chairman in the hall and he is talking to someone I haven’t met, it is 100% guaranteed that he will stop me and say, “Oh Dr. St. Claire, have you had the pleasure of meeting so-and-so-chairman-from-blah-blah-department yet?”  And then will go on to completely talk up my work ad nauseam to this poor trapped soul about how special my clinic is and all the innovative things we are doing, etc.  His elevator speech has actually gotten quite good.

Or when my colleagues refer a child to me that they just don’t know what to do with, and tell me how relieved they are that I am here and can help out with complex care coordination that they just aren’t equipped to handle as surgeons.

Or when the medical assistant screening my patient leaves me a little note on the computer in the room that says “Hi Dr. St. Claire – have a super day!”

Or when my colleagues from the community ask me to chair a committee to try to bring resources together to best serve our patients and families.  And then when we have the meeting at 3pm on a Monday, my clinic coordinator naturally assumes I will want it catered, because how on earth am I supposed to host a successful committee meeting without feeding the participants?

Or when our admin sees that I am still in my office on Friday at 5:30pm charting, and runs down to the first floor to bring me a Diet Coke so I can keep working (which may be the reason why I woke up so early this morning thinking about this stuff – caffeine and I are not exactly friends).

I could go on and on with these little encounters that individually could be seen as trivial.  But when every single day at work is FULL of these kind of interactions, you start to feel rather glowy and lovely all the time.  Do I have hard days?  Of course.  Do I occasionally have challenging families or situations that make me sad that I can’t do more?  Absolutely.  But working in an environment where I am not only liked and respected, but valued, makes me finally, finally understand what Confucious was talking about when he said,

“Choose a job you love, and you will never have to work a day in your life.”

 

I get it now.  I just had to find a job that loves me back.

 

 

Mi loca, tu loca

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For some reason, I spent the entire bulk of today fending off the phenomenon I refer to as “mi loca, tu loca”.  Which translates roughly to “my crazy, your crazy (and that plus asking for the check at dinner is just about the extent of my Spanish.)

The MLTL experience is one of the things in life that truly, deeply gets under my skin.  We all have experienced this at least once.  If you haven’t, you either live under a rock or have a life that is so pleasant that June Cleaver would shank you out of pure jealousy.  MLTL happens when someone else tries to make their crazy your crazy.  And I am not talking about garden variety attempts to convince you to see their side of the story.  No, this is actually infecting you with their particular delusion so that you begin to not only question your own logic, but the rules of all known social engagement.

People who are capable of this “talent” tend to be a) grossly incompetent and acting defensively to protect the shrine of inadequacy they have spent a lifetime building, b) smart and manipulative, or c) both.  Meeting someone who is both incredibly smart and grossly incompetent is indeed rare – it’s a bit like seeing a unicorn, except from what I have heard that tends to be a lovely experience of which many first graders enjoy drawing pictures.

Unfortunately, I spent the majority of my life dealing with mi loca tu loca from my family, although for the first 15 or 20 years I didn’t really understand what I was up against.  Regardless, you would think that would make me somewhat of an expert on how to deal with it.  Sadly, I don’t think it does, mainly because the laws of human interaction don’t apply to these soul-suckers, so often there is no rational way out.  The only benefit I can see at this point is that I am a master MLTL detector.  I am a f**cking bloodhound when it comes to identifying these folks.  The feeling is always the same – a few minutes into a conversation, I get the distinct feeling that I am the unwitting victim of a Vulcan mind meld, and that a complete stranger is somehow brainwashing me into thinking that, even thought pure logic and reality would dictate otherwise, that somehow I am in the wrong or owe them something.

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Normally, I can deal with these people on an occasional basis.  But somehow, today was the perfect storm of  folks who kept assaulting me with their voodoo magic in the hopes that I would suddenly agree that the sky is green and has three suns.

It started with a computer training that I had to complete for my new job.  Mandatory, of course.  Knowing how much I just love CBL experiences, I dutifully cancelled half a day of work to schedule a three hour training session.  And as a freelancer, that cost me.  People with full time jobs don’t always realize that taking off work for us consultant folks hits us right in the wallet.  But I didn’t mind – it’s just one of those things you do and get on with your life.

Turns out that I was the only one scheduled for this training, which meant I had the full attention of the instructor for three hours.  Initially I thought this wouldn’t be such a bad thing, as I could monopolize her with my individual questions and not feel guilty for hijacking a class.

As the session went on, however, I quickly realized two things.  The first was that this woman was truly from a computer based learning cult, and she had drunk the Koolaid.  I’m not sure how many times she waxed ecstatically over the program’s “exciting features” and “thrilling application potential”, but 30 minutes into it I was already exhausted, and she might as well have had pom poms and been wearing a cheerleader outfit.

The second, and more important, was that she clearly had an agenda for the afternoon that didn’t involve me.  I had been scheduled from 1pm-4pm, and she informed me after we were an hour into the training that there was some sort of departmental meeting that was happening that day at 3pm.

That’s when the Vulcan mind meld started creeping in.  Her tone changed ever so subtly as she told me that it was very possible that we would finish in 2 hours (fat chance), and that if we did, she could attend the meeting, but that she certainly didn’t want to shortchange my time.  And she would be more than happy to schedule another session with me at a more convenient location for me so we could complete the training and give it the full attention it deserved.  And that way everyone could get all the information they needed.

My thought process, already blunted by the assault of computer program information that had no real meaning for me yet, reflexively shifted over and I started mentally thumbing through my calendar, wondering if I could find a chink in my schedule to meet her at a local Starbucks for an hour.  mindmeldmindmeldmindmeld

Luckily, all those years of family training kicked in, and I startled back into reality.  Sorry, didn’t I already take off half a day of work to meet your training schedule, and now you are asking me to kick off an hour early and take off more work to reschedule with you so you can make some dumb meeting?  And implying that I would be selfish not to?

Hell no lady.  I politely but firmly informed her that this was the only day off this week that I was able to schedule this session (which was true), and that rescheduling for one hour of training simply wouldn’t be possible.  She said of course she understood, but her expression completely conveyed the opposite.  And she couldn’t resist one last dig (mindmeldmindmeldmindmeld) when she said she was pretty sure she could get the critical information she was missing from a colleague.

Once I had completed ALL THREE hours of training (with her becoming increasingly flustered after all that song and dance at actually being time pressured to finish), I was happy to get home and relax.   Yet almost immediately, I got sucked into a ridiculously lengthy email exchange with an agency that had hired me for some consult work, accepted my terms of service, and then negged on paying my full invoice, claiming that reimbursement for travel and overtime had not been preapproved.  The pinnacle of this asshattery was an email from the SENIOR accounting manager, who actually said, “I don’t know you at all….but c’mon….we’re all Human.”  I mean, who talks like that?  As if I am somehow going to suddenly bolt upright (mindmeldmindmeldmindmeld) and say, “By golly, you’re right!  Who cares if you bilk me and all your other contractors out of money we are owed and propagate ethical fraud on the professional community at large?  I mean, c’mon!  I must have been crazy to complain to you!”

C’mon is right.  You can keep your !@#$%^& loca to yourself.  🙂

~lumi