Ski Practice

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Cross-posted from the heenastat blog.


 

To her it was like any other day. She had dropped him off, as was their usual routine, and gone into the city to see a friend.

He was an experienced member of the ski team. Practice was familiar. Take the lift up, ski down. Take the life up, slalom down. Take the life up…

It all happened quickly. He slipped through rail of the lift. The impact on the cold, hard packed snow was devastatingly complete. Perhaps it was his head, or maybe his spine, but vital functions were cut off immediately; he went into cardiac arrest. The ski patrol started CPR. Someone alerted dad. He arrived almost as quickly as the paramedics. They intubated him with efficiency and continues advanced cardiac life support.

He arrived as my patient immobilized with a long spine board and a cervical collar. He was intubated and CPR was ongoing. He had lost vitals signs at least 20 minutes ago. Dad was by his side as he rolled into the trauma bay. We kept coding him for the next 45 minutes. His pupils were blown. His skull base was boggy. We knew it was futile but he was someone’s child. It was hard to let go. But we did.

When I told dad, he was alone. He had not grasped the magnitude of on-going CPR and was utterly shocked when I told him his son was dead. My lip was quivering as I delivered the crushing news; my tears followed soon after he began to sob.

He asked me to call his wife. I told her it was serious and to arrive quickly but safely. Her grief is something that I will forever hold with me. I cried with her too. And, though it was not the first, nor would it be the last, time, that I would cry with a family experiencing sudden loss, my ability to be with these parents–REALLY BE WITH THEM–at the darkest moment of their lives reminded me, somewhat paradoxically, of the joys of my profession.

The Final Chapter

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Cross-posted from the heenastat blog.


 

He had loved her with all his being for more than 6 decades. In the last 2 years of their 61 year marriage, he had watched helplessly as dementia wrapped its noose around her, slowly tightening its grip on her mind and pulling her away from him.

When I met him I knew the injury was irrecoverable. Her brain was consumed by hemorrhage that had filled the space (cerebral atrophy) left behind by progressive dementia and then some, deflecting the midline between the two hemispheres nearly 12mm.

I asked him what had happened. She had tripped and fallen. For all her mind’s frailty, her body was still strong and agile for her 83 years; how she stumbled in the small living room they had shared for more than 50 years remained a mystery.

She was still breathing on her own but her brainstem’s ability to preserve this vital function was succumbing quickly to the pressure building from above. She appeared to be peacefully sleeping. He had not yet grasped that she would not be waking up.

I asked him what life was like at home before today. She was no longer aware of who, what, when, where, and how. A nurse would come daily to help her bathe and dress. She would then spend most of her day in a trusty old recliner. He would cook and feed her, then put her to bed every evening. They had no children. They had outlived their siblings.

Theirs was a story of two lifelong friends and lovers. Every Sunday he would take her for a drive. He wanted her to see the sun and the trees and the world outside their home. This was romance in the denouement of life. And here I was, suddenly a supporting character in the final chapter of their love story.

He cried quietly as I explained the magnitude of the injury. Like too many of my octogenarian patients, she had no advanced directives. None of the providers who knew her far better than I had thought a discussion of code status was worthy it seems. So this was my role.

We talked for a long while. After reviewing what all the technology in my critical care armamentarium might do and not do for the love of his life he said to me, “I don’t know I what will do without her. I don’t know any other life. I don’t have anyone else.”

His heartache was palpable.

There was surprise and some expression of dismay at the administrative hassle I caused when I planned to send her home with hospice services directly from the ER that day. I am grateful for the ER physicians, nurses, and social workers who helped me execute that plan even though it would have been far more convenient for us to simply admit her to the floor.

That she would die peacefully in her home of five decades with her partner of six by her side is the kind of medical outcome that looks poor on paper but feels good to the surgeon’s soul.

Who am I?

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Long time followers of this blog know that we started it based upon a shared quest to be better to ourselves, our bodies, our families in the midst of very demanding careers as trauma surgeons. As the one who started the blog, I must admit that my initial intention was to focus on what made us whole outside of work. And so, much of the content, especially early on, was about our shared interests in hot heels and all things fashion, our efforts to stay healthy donning our cool kicks or our ballet socks, and our challenges as wives and mothers whose day jobs require a scalpel.

But as time passed, we wrote more and more about our professional experiences, because it turns out a large part of our whole is what we go through at work. After all, with 4-10 nights per month on in-house call and standard 120 hour weeks on service in addition to research, service and society work to advance our academic careers, we spend many, many more hours on the work part of ourselves than the outside of work part of ourselves.

Since my hope had been to share the outside of work part of ourselves in this blog, as I found myself writing here more and more about work related issues, I recently created separate blog. I told @surgeoninkicks it would be my “professional blog” where I could share some of the darker stuff that affects us (i.e., someone interested in my Jimmy Choos may not want to be confronted by the sorrow that I feel when I lose a patient). It would be a blog where I would write about the experiences that help me maintain joy in the profession.

However, the reality is that the two sides of our worlds are not separable. Maintaining joy in the profession in inextricably linked to finding joy outside of work. @surgeoninkicks understood this but it took me longer to confront this reality of who I am.

I am a surgeon in a specialty with extraordinarily high rates of burnout, with hours that pose significant logistical challenges to self care, family life, and extracurricular activities, and with routine exposure to human pain and suffering. I do feel joy in doing my best to care for patients and their families. I did choose a career path where I would be balancing non-clinical and clinical work. I do have a husband, two children, a dog, many friends, and interests outside of work. I do feel stress in juggling it all and routinely engage in retail therapy as an elixir. I am not nearly as fit and healthy as I want to be. This is who I am. 

So, this week I will migrate the few posts from my other blog into this venue. I will continue to write about all the facets of who I am in this blog, a blog I am so lucky to have shared with a true soul mate in @surgeoninkicks.  She has seen me through this crisis of online identities and I am ready to share completely. Thank you for the continued readership. Your enthusiastic support of our work is greatly appreciated.

When Doctors Aren’t Safe at Work

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I walked through the double doors of the Trauma ICU just like any other morning.  But that particular morning, instead of being met by my favorite nurse or a fellow resident, I was met by two men wearing balaclavas and carrying assault rifles.

This was the first time I realized that maybe I wasn’t safe at work.  I was a second year surgical resident.  Chicago was in the middle of yet another gang war.  We were treating patients that had been involved in this urban warfare, and “credible threats” had been made not only against those patients, but also against the hospital.  The men in the balaclavas were part of Chicago PD, and they had our entire trauma unit surrounded – to keep us safe.  And for that, I am greatly appreciative to this very day.

But that is when it hit me, why does the supposedly safest place, a place where healing occurs, need assault rifles to keep it and its workers safe?

This morning I am met with yet another story of a doctor being murdered at work.  My heart goes out to his family, his coworkers, and New Orleans.  As a medical community we are again brought together – not to celebrate a stunning breakthrough in the treatment of a disease, or a patient success story – but to mourn.

According to the Occupational Health and Safety Administration (OSHA), the vast majority of workplace assaults occur in a healthcare setting.  In response, hospitals are locking doors.  Installing metal detectors.  Hiring security.  And allowing those guarding its doors to carry guns.  Is this the right answer?  I don’t know.  What I do know, is that regardless of political affiliation, regardless of race or socioeconomic status or religious beliefs, we have to come together and at the very least, return our safest places in America, our havens from the outside world – schools, hospitals, and places of worship, back to safety.

If we can’t do that, then will any of us ever truly be safe again?

This mother should be ashamed

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As many of you know, “rough” has not been an adequate enough of an adjective to describe the past week for my hospital and my community.  We have lost people who mean a great deal to all of us.

So, you can imagine my abject disgust when I heard about, and then read, this post from Kevin MD – “5 tips for parenting a future surgeon”.  Feel free to read it, or I will be glad to summarize it here.  This was written by an anonymous mother of a surgeon who states, “Mamas don’t let your babies grow up to be surgeons” and then proceeds to list all the horrors of allowing or encouraging your child to become a surgeon.  Let me list them for you here.

Surgeons yell a lot.  Surgeons curse.  Surgeons don’t give out praise.  Surgeons don’t get enough sleep at night.  AND because medical school costs money.

Anonymous mother – you should be downright ashamed of yourself.  And let me clearly, and as plainly as possible, tell you why.

Doctors, and surgeons in particular are a national shortage.  Sure, the world existed before surgeons, and the world would exist without surgeons.  But, I don’t think I’m out on a limb here by saying that we save and improve lives daily.  For example, think of the over quarter of a million people every year who need to have their appendix taken out.  Most people think of appendicitis as a fairly benign or mild disease.  However, without a surgeon, and even with antibiotics, a significant proportion of those patients would suffer and potentially die.  This doesn’t even begin to address the other whole host of diseases that we treat and even help cure – breast cancer, colon cancer, gallbladder problems, heart disease, bowel obstructions, and traumatic injuries.  Fact of the matter is, without surgeons, life expectancy would quickly and expediently drop.  But hey, feel free to go around encouraging people not to go into a profession in which the only goal is to help other people.

Yep, medical school costs money.  And yes, the vast majority of us need loans to pay for the education.  But last time I checked, universities, and community colleges, and trade schools also cost money.  And a lot of people also need loans to pay.  Should no one pursue any sort of education that costs money unless they can pay for it in cash?  That seems just slightly elitist from my perspective.

Hmm – okay.  Well let’s keep going.  So, should no mother allow their child to join the military?  I have a hard time believing that someone could make it through any sort of military training much less SEAL or Ranger training without getting yelled at… or cursed at… or sleep deprived for periods of time.

And lady, you want to know why?!  Because what they do, and what we do, is serious.  And some might even say stressful.  Like, you know, life or death kind of stressful.  Handing out trophies is NOT going to prepare someone for those types of situations.

I am not excusing abusive behavior.  What I would like to ask is what kind of training do you want your surgeon to have?  Being told they are right when they are wrong?  Not learning to perform under some semblance of pressure?  Because let me tell you how that will end up – with you on an operating room table and an incredibly unprepared surgeon looking down at you.  Good luck with you on that… let me know how it turns out for you.

Just for the record, my parents are kinda proud of me.  They think the fact that there are people living today, waking up and going to work, kissing their loved ones goodbye because of me, is pretty cool.  But hey, if you think your child not getting yelled at is more important than that… well, I have heard it “takes all kinds”.

My real advice to you?  Go find a surgeon, and hug them.  Because they chose to go through years and years of rigorous training all to help you.  And although there may not be a real trophy at the end, keeping people alive seems to be reward enough for most of us.

A Surgeon’s Survivor’s Guilt

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My heart tells me I lost them.  My brain tells me I never had them to lose.

One of my mentors has said that all trauma surgeons have their own personal graveyard, filled with patients we couldn’t save, and families’ hearts left broken.  A truer statement has never been said, and this weekend, this trauma surgeon’s graveyard has increased yet again.

The feelings that accompany this increase are always varying and deep.

There is anger.  True wrath.  When the hell are we going to figure this out?  When are we going to stop shooting one another?!  When are we going to learn that drinking and driving can be deadly?!  When are we going to start respecting ourselves, our bodies, and one another?!  When are people going to stop paving a path of destruction for themselves and others that is wide and immeasurable?!

There is sadness.  Sadness over the pain and the fear that my patients surely felt.  Sadness over the waste of life that we witness.  Sadness for the families left behind, in a new world they never anticipated.

And yes, guilt.  Guilt over being able to go home, when our patient couldn’t.  Guilt for leaving the hospital to enjoy my family knowing another family has just been destroyed.

This weekend was a particularly rough one for myself, and the hospital at which I work.  Although to most people around the country, it was just another act of violence, to myself and our community, it was felt deeply.  Every person in our hospital was stung, upset, and shocked.  Everyone knew what happened – I received touches on the arm, knowing hugs, and reassuring smiles.  They knew I did everything humanly possible even when the inhuman was needed, but that knowledge is a poor salve against this type of wound.

So please, if you know someone who works in healthcare – give them a hug, a high five, or even a thank you.  I have said before how we all take you, our patients and communities, home with us at night, but please also know that our lives are never the same either.  Every patient encounter alters us – sometimes subtly, and sometimes drastically.  We are changed, and we never forget.

Stay safe.

Yes, burnout existed 30 years ago – but how today’s hospital culture is making it worse… aka the “Twitter effect”

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Burnout, burnout, burnout.  It seems like that is all anyone wants to talk about these days.  And I admit, some days, I can get burnt out on burnout.  But, all the attention on the subject got me thinking… did burnout not exist 30 years ago? Why is this such a hot topic now?

And that is what brings me to this post – I came to the realization that burnout very much existed 30 years ago, but that the current “write-up” culture, and what I affectionately refer to as the “Twitter effect”, that is now prevalent in healthcare and most US hospitals has made it infinitely worse.

Let’s face it.  Surgeons have a reputation – bossy, mean, rude, impersonal, hard to work with, and difficult.  And, this reputation, just like Rome, wasn’t built in a day.  It wasn’t even that long ago (during my training years) that surgeons would throw instruments, throw nurses, medical students, even anesthesiologists out of their operating rooms, or yell, scream, and curse to their heart’s content.  Infidelity and extramarital affairs were rampant, paperwork wouldn’t be completed on time, and bad outcomes only had to be discussed at a weekly Morbidity and Mortality (M&M) conference and only with other surgical colleagues.

Clearly, most of the above described behavior is unprofessional, inappropriate, and unacceptable.  But, what it did do was provide a mechanism, a valve so to speak, with which to vent anger, frustration, sadness and fatigue.  And, for a very long time this behavior was viewed as a fact of life.  Nurses would talk amongst themselves, junior residents would get stuck having to operate frequently with the most malignant personalities, clerks and environmental services staff would just look the other way.

But then, over time, we became enlightened.  We became proactive in empowering any and every one to speak up against unprofessional behavior, sexual harassment, or profane language.    We began to focus more and more on ways to measure performance. How long does it take for a physician to complete their paperwork?  How many patients are you seeing in a day compared to your peers?  Hospital complications are now labeled as “never” events.   M&M’s have become Disney World vacations when compared to having to re-live bad outcomes over and over again in hospital-run root cause analyses and peer review sessions to examine the role of the physician in bad outcomes.

But somewhere in all this enlightenment, we have lost the true message of healthcare.  

Healthcare is about relationships, not write-ups.

We have now cultured a culture in which having a bad day, losing one’s patience, or not smiling enough can now lead to getting “written up” by anyone in the hospital – student, resident, nurse, clerk, patient, etc.  The filling out of paperwork, and the careful coding of certain physical conditions so as not to get dinged by the hospital for providing “suboptimal” care, are now fodder for write ups.  Physicians are held captive and measured by the electronic medical record, NSQIP, 360 degree evaluations, and quality metrics.

So what does being written up mean exactly?  It means meetings (often multiple) to discuss said incident or incidents, papers being placed in personnel files, and sometimes poor job evaluations.  I call this the “Twitter effect” – anyone can say anything at all about you, true or false, whether you have worked somewhere for 15 years or 15 minutes… and it gets attention.

Don’t get me wrong here. Professional behavior should be expected at work, and we should always strive to be better physicians, nurses, healthcare workers and humans tomorrow than we are today.

But, punitive attitudes and actions are NOT going to result in any of that.  I have never written anyone up in 11 years, and I pride myself on that because it does not change behavior.

Bottom line, if someone is an a**hole, writing them up is not going to change that.  And, if someone just had a bad day, or is having a rough week, having a relationship with them, being able to engage them in a conversation, will change their future behavior. A piece of paper will not.  Most times, people already know when they messed up, giving it undue amounts of attention only lead to feelings of defensiveness and self-doubt.  And the truth of the matter is bad days happen to all of us.

I am human.  Am I at my best after 36 hours of call inside the hospital with 60 patients on service, back to back emergency surgeries and emotional discussions with families about poor outcomes for their loved ones?  Absolutely not.  But am I still expected to smile, teach residents, make the medical students feel comfortable, get daily paperwork done within 24 hours, have the patience of Gandhi and not make any errors in clinical judgement?  You better believe it.  And, for the most part, I’m 100% okay with that.  I signed up to be a surgeon, I didn’t draw it out of a hat.  However, the feeling of walking on eggshells, the inability to have a bad day, lose one’s patience, or be anything other than perfect is soul-crushing.

I feel this especially as a trauma surgeon.  Surgeons in general are at a national shortage, and especially so with trauma surgeons.  Most institutions are not running fully staffed, leading to more call nights, longer hours, and more fatigue.  And no, this isn’t subjective. Being a trauma surgeon and the amount of call a physician takes have both been directly associated with the development of burnout.

Gone are the days where a surgeon can throw an instrument or curse out an entire operating room… and good riddance, quite frankly.  But also gone are the days in which anyone can have a bad day, get frustrated, or maybe say the wrong thing, and have it understood or handled without a paper trail.  The relationships we form at work are meaning less and less, and paperwork is meaning more and more. And, until we change this – until we change the punitive and negative culture within healthcare – we will continue talking about, and becoming, burned out.

Today Nearly 300 of Us Will be Killed or Injured with a Gun

My heart is heavy this week due to gun violence. Today, it is a mass shooting that happened afar. Most days it is something that happened in my own trauma center’s catchment area.

Some people ask why I only speak up about our nation’s epidemic of gun violence when there is yet another mass shooting. After all, as a trauma surgeon I am all too familiar with the daily toll of gun violence one person at a time.

Whether it is the young urban dweller who lacking hope for a good future, in the absence of socioeconomic security and educational opportunities, turns to a life in gangs armed with illegal guns and ends up in a crime fueled shootout…

Or the depressed middle-aged suburbanite who under the oppression of dark feelings related to job loss or divorce or perhaps seemingly no obvious stressor attempts to take their own life with a hand gun…

Or the believer in concealed carry who, in a state of inebriation, engages in what might have otherwise been a simple fisticuffs that instead turns out to be a deadly bar fight…

Or the curious child who, due to the momentary carelessness of an adult who would swear they are an educated legal gun owner compliant with best practices for firearms safety, pulls the trigger with a devastating outcome…

Or the bereaved, yet obviously mentally unstable, individual who acts on his grievances against his mother’s surgeon by gunning him down in the clinic

Or any of the 297 Americans killed or injured daily due to firearms, as trauma surgeons, my colleagues and I bear witness the death and destruction caused by our nation’s obsession with the right to bear arms first hand each and every day.

While it’s a thrill for a trauma surgeon to get a great case—it might be the adrenaline surge of doing an ED thoracotomy on a coding patient with a hole in the heart or the exhilaration of the exploratory laparotomy requiring 4 or 5 lacerated organs to be repaired—but as a human, each and every time I am called upon to care for someone who was shot, no matter what the circumstances, I feel sick to my stomach. My soul grieves for those who I can’t save, for those who will be left permanently disabled, and for everyone—patients, families, and caregivers alike—who will share the post-traumatic stress of having gone through the shooting and its aftermath.

This should not be happening in a civilized society.

To be sure, there are myriad other issues that contribute to gun violence in our country ranging from economic insecurity to mental illness to extremist beliefs to the ubiquitous violence we see in our LED lit world today. And, let’s not be naive; many objects can be weaponized to intentionally or unintentionally injure, maim, and kill others. As we have come to know from the fertilizer used in Oklahoma City to the ball bearings used in the Boston Marathon to the box cutters and airplanes used on 9-11, to the beer bottles, lead pipes, knives, bats, and automotive vehicles that we surgeons see as causes of trauma every day, it’s not just guns that are the problem. But it is foolish to think that these other issues contributing violence in all of its forms trump that of essentially unfettered access objects that, in any form—shotgun, handgun, semi-automatic—have a singular purpose: to injure, to maim, or to kill. The original purchaser’s intent may have been different—perhaps for target practice or for hunting animals or for self-defense borne out of paranoia of threat to personal property that is seemingly rampant in our society—but it’s just too easy, no matter how the gun was acquired and by whom, for guns to be used to cause harm whether by murder, or suicide, or terrorism, or accident.

And so, when there is a mass shooting that attracts the social media outcry of those around me—those known to me from near and far and those unknown to me who simply come across my news feed—I do speak up more vociferously than I do in my everyday life as a trauma surgeon because, in the deepest depths of my heart, I am hoping that this increased attention might galvanize WE THE PEOPLE to find it in our collective consciousness to finally take steps to re-envision what the right to bear arms means in a civilized society. No other country accepts this as an inalienable right; and, as a result they don’t see nearly as many deaths and injuries due to firearms as we do. But we hang on to this 18th century notion as a point of American pride. It’s time for 21st century Americans to figure this out because today nearly 300 more of us will be injured or killed by gun violence.

Hey Carpool Mom, Your Vehicle is NOT a School Bus and Boys are NOT Cargo

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Hey Carpool Mom! Yeah, that’s right I am talking to you in your Yukon XL SUV.

Even though your vehicle is the size of a bus, it is not, in fact, a school bus. Therefore, stopping in the middle of a busy road to load a dozen boys into your vehicle is a really bad idea. You have no flashing stop sign jutting out on your driver’s side so there’s nothing to keep oncoming rush hour traffic from bowling into the boys who clearly have not been taught to look both ways before crossing the street. Or, perhaps your random stoppage in the middle of the road led them to believe that they too could put aside any regard for their personal safety in the rush to leave practice.

Way to role model Carpool Mom! Your friendly local trauma surgeon suggests that you consider pulling over at a safe location, with your signal on, and have the boys look both ways and use the cross walk before piling into your SUV. Unless of course, you are trying to cut down on the volume of boys you must drive around by encouraging brain injury, internal bleeding, long bone fractures and the like because, well, that is a strategy I suppose for the exasperated Carpool Mom.

How many seats does that behemoth have anyway? Does it come equipped with seat belts as most modern American vehicles do? Because by my count, even with that extra row of seats in your giant SUV, there were 2 too many boys in the passenger area of your car. So I guess it’s no surprise that not a single one of them made any effort to put on a seat belt after piling into your vehicle. I suppose that goes hand in hand with the street crossing technique you and your, ummm, safety consciousness have inspired in these boys. Oh, and I bet you are thinking I should not frown upon the two who piled into the cargo area for not putting on seat belts because, well, there are no seat belts for the cargo area.

So again, your friendly local trauma surgeon would like to gently remind you that seatbelts save lives. Oh, and it’s the law in our state to have those boys in restraints. Also, there’s a reason it’s a cargo area and not a passenger area: boys are NOT cargo. If your ginormous vehicle is still too small to handle the entire team, why don’t you consider asking another parent to help with the carpool? Surely there is someone else willing to share the Carpool Mom of the Year Title.

Because clearly your nonchalant wave back at me as you pulled away indicated that you relish that title. However, it seems to me that you are undeserving of the title since you are seemingly oblivious to the risk you have exposed these boys to with your carpooling technique. You were lucky that oncoming traffic stopped and let the boys barrel across the street just feet from a crosswalk without bothering to look both ways. And, if you stop short during the remainder of your journey, two boys will be flying out of the lift gate window. If you cut a turn too sharply through the center of town, bodies will be careening into each other and the metal cage you have tossed them in without proper restraints. Or, if you get rear-ended, at least one of them will strike his head on the back of your seat and you might be trading in your damaged SUV for a wheelchair van.

As your friendly local trauma surgeon who has held in her hands the brain matter of boys struck by automobiles while haphazardly crossing the street and has had to deliver the sad news that a boy will never walk again due to lack of being restrained in a vehicle that crashed, I hope that you, Carpool Mom, are prepared to live with your grief and the grief of the other parents, when your “I’m indestructible” attitude gets a harsh reality check.

Here's the SUV in question. Vehicle details have been anonymized to protect the guilty.

Here’s the SUV in question. Vehicle details have been anonymized to protect the guilty.

Each year, 1,600 motor vehicle passengers under age 15 die while nearly 130,000 more are injured in car crashes in the United States; and, nearly 300 more die while another 10,000 are injured when they are struck by vehicles. More than half of the children killed in car crashes are unrestrained. Proper restraint use reduces motor vehicle related morbidity and mortality by more than 50%. Furthermore, jaywalking and lack of attention to oncoming traffic are the culprit in well over 50% of adolescent pedestrian vs. auto deaths. Today, Carpool Mom, you encouraged those boys in your care–entrusted to you by their parents–to jaywalk and they most certainly did not look both ways before getting into your over-filled vehicle that you then put into motion without having the boys properly restrained.

So next time you are in charge of carpool, ask yourself, “how would the other parents feel if I had a party and served alcohol to their sons?” Because today you might as well have gotten those boys shit faced drunk with the example you set for them and the risk you exposed them to. I was not on call to accept incoming injured patients this afternoon, but I sure hope everyone got home safely.

Hypocrites in our own house: Maternity leave and American Healthcare

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Netflix listens to doctors.  Google, Facebook, and Apple listens to doctors.  The United States Navy and Marine Corps listen.

The above “companies” have updated their maternity leave policies – lengthening them all past 12 weeks… and all paid.

But yet, healthcare doesn’t listen to doctors.  And let me tell you how.

I am pregnant.  Which is a blessing in of itself.  In fact, this is my 4th pregnancy, but I only have one child living.  So really, this is an absolute blessing that I have had a healthy pregnancy so far.  I should be over the moon excited.  Yet, there has been a black cloud over my heart since I first saw the “yes” on the pregnancy test.

Currently, I am the sole income for our family while my husband is in law school.  And yet, my job does not provide fully paid maternity leave.  The thoughts and stress of how we are going to balance our financial needs with my family’s emotional need for me to spend that precious, once in a lifetime time at home with our new son has left me downright drained.

I am currently in “discussions” with my large academic health physicians group as to how much paid leave I will actually receive for maternity leave.  And let me tell you, their initial response was significantly less than 12 weeks.  I think for me, the most disheartening part of these “discussions” with my employers is that they keep asking themselves, “Well, what have we done in the past?” instead of, “What should we be doing?”  Despite the fact that I will need a repeat cesarean section.  Despite the fact that due to short staffing over the past 3 years, I have given up 8 weeks of vacation and worked extended hours for years – including in-house calls up to 62 hours in a row.  Yep, folks, you read that correctly.  I have literally come in to this hospital on a Friday, and not left until a Monday morning.  And I have done it, because that is what the job required, what my hospital needed.  Trauma surgeons are a national shortage, and my profession often calls for dedication above and beyond the imaginable.

I always felt like that dedication was well placed – for my patients, for my hospital, for my community.  And that this dedication was shared by healthcare in general.  However, I feel that maternity leave is an issue that highlights my belief that for many institutions and practices, healthcare has lost its focus.  Healthcare should be about caring for people – our patients and each other.  Healthcare should be setting the standard for how other companies handle maternity leave – yet we are amongst the worst hypocrites.

After all, we are the ones recommending that women exclusively breast feed for a year – yet practice administrators dictate whether or not physicians can build 15 minute pumping breaks into their schedules.  We recommend women not return to work for 8 weeks after a cesarean section, yet we don’t pay them.  Several studies have shown that women who return to work before 12 weeks have children with more behavioral problems in early childhood, yet, if she doesn’t come back by 12 weeks, we take away her job.  We know that depression is directly linked to a lack of time off after the delivery of a baby, yet we continue to point to the letter of the law and say that what we offer is enough.  I wish these examples and studies weren’t real, but they are.

The dollars and cents seem to matter more for those that employ physicians than the health of their physicians.  The disparity of how maternity leave is handled amongst physicians here in the United States is downright shocking.  Some institutions automatically grant 12 weeks paid, but these unfortunately are in the minority. Most pregnant physicians are in a similar situation to me, and are left to fight, scramble, and scrap together time off after delivery and even time to pump when we do return to work.

And the kicker of it is, the physicians are usually the worst hit by these policies.  If I were a nurse, or an hourly employee, I would be able to roll over or accrue my vacation days. Other employees could even donate paid time off to me.  I would be mandated lunch and work breaks so I could pump.  I would never be left wondering how I could safely store breast milk for up to three calendar days. But yet none of these options are typically available to physicians.

I wish this were one of my usually snarky, humorous, Gomerblog worthy posts, but it isn’t. Unfortunately, I am writing today from a place of hurt, a place of feeling abandoned by my own profession – the people that are supposed to care about my health the most, seem to care about it the least.

I hope and pray, for the future of healthcare here in America, that these policies will change – to the benefit of the physicians, and the patients for whom we care.  After all, if we can’t take care of ourselves, how are we supposed to care for others?