If Your Nose Is To The Grindstone, You Had Best Keep Your Head on A Swivel And Watch Your Ass
Dwelling on the past can be quite unbecoming. Think of Napoleon Dynamite’s Uncle Rico who arrested in development during his high school football glory days. While the childlike immaturity may be charming for a while, it’s only a matter of time until you do something boneheaded to Starla and earn yourself a personal, one-on-one clinic in Rex Kwon Do. A merciless, but well-deserved, beatdown from a guy wearing American flag parachute pants. An unforgettable lesson in humility.
That said, history can be quite instructional. What better way is there to learn valuable lessons of all varieties without having to have any skin in the game whatsoever? It is interesting how easily we can find examples of people making the exact same mistakes over and over again. The outcome remains constant. Insanity, right? For the discerning, understanding history is a great tool.
I have a story to share. It is more or less the prequel to an earlier post (Overcoming The Dark Scourge Of Beardophobia) and should provide a bit more context. I have been reluctant to discuss it much publicly, because until now, I didn’t see much point in it. While the transitional events leading up to the crux of the story were developing, honest, frank talk was dubbed as insubordination and was treated with marginalization and termination. Aside from having legitimate concerns about retribution, it can be difficult to discuss one’s grievances in a manner in which one does not come across as a whining-assed bitch.
To be clear up front, I have learned an immense amount from this chain of events, which spanned several years. Excerpts from the story I will discuss below, but the situation was so nuanced that it would needlessly detract from the main point to try to hammer out every detail of what transpired. Perhaps I will highlight some other lessons learned at another time. Perhaps not. Either because of these experiences, because of the manner in which I chose to perceive them, or a combination of the two, I am flourishing. Thriving. My frame of reference is not one of defeat, but victory.
I have long believed that the best way to approach difficult times in work and in life was to simply put your nose to the grindstone and push on through the circumstance. I thought that as long as I was working hard, focusing on good outcomes, minding my own business and treating people well that things would work out in my favor.
After I finished my surgical critical care fellowship, my first attending surgeon job was at a level 1 trauma center in northeast Tennessee. It was a hybrid arrangement where I was employed by both a local university and a local hospital system. The job was amazing. Truly. I really couldn’t have asked for a better experience than the first few years there.
Over time, I started to see some problems with the system, but it really didn’t bother me. No place is perfect and every place has its unique challenges. As long as I was able to do my job without being harassed excessively, I was content. My goal was to develop my craft, work hard and stay out of the politics. I stayed very busy clinically. Too busy probably, but I viewed it as a continuation of my fellowship and an opportunity to sharpen my skills. The goals were simple:
Provide excellent patient care.
Provide excellent education to the students and residents.
Create and foster a multidisciplinary team atmosphere.
We accomplished the mission, but after several years, there were rumblings about changes being on the horizon. The first change was a merger of hospital systems which created a regional health care delivery monopoly. It was a period of great uncertainty. The second change was the inevitable series of closures and consolidations of services.
The process evolved over many months and the unrest that it prompted within me lead to me taking two courses of action: (1) I secured a part-time job out of town as a safety net and (2) I enrolled in a business program at the University of Tennessee (because I realized that while I could hold my own clinically, I was ill equipped to engage in the dark realm of the business of medicine). I despised the politics. I despised the meetings because they took time away from doing what I loved: practicing medicine. I could care less about the who’s who in the C suite. It wasn’t that I didn’t care about them as people or see their value. It was more that I saw our worlds as separate and I felt that from a pragmatic standpoint, to do my job well, I needed to minimize distractions and focus on clinical excellence. It took me years to recognize that these were my blind spots and that all of these things are a necessary part of the game. As you will soon see, in this case I waited until my trust in the system was so compromised that it was imperiled beyond the point of salvageability.
So, talks of changes to the trauma system began early in the transition process. There were multiple iterations of the grand plan, but what ultimately was revealed was that we were going to “downgrade” one of the state level 1 trauma centers to a level 3 trauma center. Logistically and from a functionality standpoint, our hospital seemed to be the best choice to remain as the level 1 (My admittedly biased opinion). Politically, the other hospital had the clear advantage. Outside reviewers came in and went through the motions of doing “assessments”. It was publicly and privately debated. In the end, the new hospital system’s level 1 trauma center was going to be at the other hospital. That’s business.
A few things about the way that it went down really hindered my trust in the new regime. First, the hospital owned surgical group at my hospital and much (if not all) of the nursing staff were told officially about the plans before the public announcement, which is when I was informed about the decision. Obviously, treating the stakeholders with respect, even if it was disingenuous, would have been the wisest from a public relations standpoint. Second, I went to a “town hall meeting” because I didn’t know what the hell was going on. No one, and I mean no one had engaged with me in any way. There was no flow of information. I was in the dark. At the meeting, the system Grand Poobah got up in front of everyone and informed them that they were actively in talks with the trauma group (Me. My group.) and that we were actively planning out the new direction of the trauma program. Exsqueeze me? Baking powder? Asphinctersayswhat? Did I hear that right? I raised my hand, waited to be recognized, introduced myself and pointed out to him as kindly as I could that what he was saying wasn’t true. He seemed to genuinely believe what he was saying and appeared surprised by my rebuttal. He and his people vowed to look into it and fix it. I waited for a while, but it soon became crystal clear that there was no immediate plan for me to have a role in the new system. I felt like waiting for them to figure out what they wanted to do would be in essence letting them control my destiny, so I resigned and recalibrated.
Now, while I still believe in the value of hard work, I have revised my previous belief to something more like work hard, but keep your head on a swivel and watch your ass at all times. Alertness and awareness are critical. Ignorance is not always bliss in the end and it’s better to be able to see the projectiles being hurled at you and obstacles in your path so that you can react accordingly. While there may be malicious intent involved sometimes, way more often, it is simply people and businesses looking out for their own interests, which may not coincide with yours. Keeping your head down leaves a huge blind spot and makes you highly vulnerable. Work hard, but also work smart.
Business decisions are business decisions, and I don’t have a problem with a business decision being made that doesn’t go my way. C’est la vie! Health care as a business muddies the water a bit and I’m not sure that viewing it through the same lens is entirely legitimate. It’s like comparing an apple to an asian pear. And then there are the ethical questions that abound about the appropriateness of health care delivery monopolies in what is supposed to be a capitalistic, free enterprise system. These weren’t my issues to sort out.
Ultimately, the questions that I had to answer were centered around whether or not I could trust this new corporation, and objectively, no matter how hard I tried, I found no reason to. Maybe I was too forthright about my skepticism. Maybe I was too vocal about my concerns. In any case, it’s history now. Water under the bridge. I choose to hold on to the memories of the many wonderful people and the many fantastic adventures that we had on our journey and let the other bullshit be swept away into the cesspool that it belongs in.
Afterward:
After writing my original draft of this post, I asked a trusted advisor to review it as I often do. While I am quite satisfied with a raw, unapologetic approach to saying what I feel like needs to be said, I realize that what I say and the manner in which I say it impacts more than just me, so I try to be considerate. I appreciate the feedback but don’t always incorporate it into the final product. Once she was done reading it, she asked basically what the purpose of the article was. I think that she was uncomfortable with some of the more explicitly spelled out details and was unsure of whether or not they were necessary. I would have hoped that the purpose would have been readily apparent, but in case it wasn’t, allow me to explain the purpose of sharing the above events a bit further.
Personal
Catharsis. There can be a therapeutic effect to remembering events of the past and telling the story can help one achieve closure.
Reflectiveness. Much like studying history, reflecting on one’s successes and failures can increase the odds of making good future decisions.
Community
Shared experience / collective wisdom. It is my hope that others can learn from my experiences, decisions and observations, and use them to enrich their lives. In order to accomplish this goal, I must share.
Unfinished business. People come and go, but it’s possible that there are people out there that wonder what happened and why. While I am sure that more people really don’t give a shit than care what happened (not out of hate, but rather because it doesn’t impact their day-to-day life), I feel that I owe it to the quiet minority.
Until next time…
